Biomedical subjects

S Sadoshima

Publications and source records attributed to S Sadoshima.

At least 55 records · Page 3Linked to original sources

PubMed1995

Brain infarction developed in hypertensive and normotensive patients during hospitalization--hemodynamic factors.

To determine the effects of changes in blood pressure (BP) on the development of ischemic stroke, 17 patients who developed acute brain infarction during hospitalization were analyzed in relation to the vascular risk factors such as hypertension, previous stroke, diabetes mellitus, and hyperlipidemia. Their BPs were retrospectively referred to the onset of stroke. The average values of mean arterial blood pressure (MABP) on admission were 137 mmHg in hypertensive patients (HT; n = 9) and 101 mmHg in normotensives (NT; n = 8). HT patients received antihypertensive treatment after admission and MABP decreased by 22 mmHg (14%) prior to the ictus (three to sixty-five days after admission). MABP in NT patients remained constant before the attack (-1.4 mmHg, four to one hundred ten days after admission). Similarly, MABP decreased by 17 mmHg (four to ninety-three days) before the ictus in patients with previous stroke (n = 9), whereas it changed only a little in patients without history of stroke (n = 8). BP in each group elevated immediately after the stroke and gradually decreased to 90% of the resting level after two weeks. An excessive reduction of BP may induce brain infarction in HT or chronic stroke patients or cause it to recur.

Acute Disease↗

PubMed1995

Cerebral blood flow and metabolism in hypertensive patients with cerebral infarction.

The authors investigated, by positron emission tomography, the effect of long-standing hypertension on cerebral blood flow (CBF) and oxygen metabolism in patients with chronic atherothrombotic brain infarction. In the nonbrain infarct (non-BI) group (n = 13, mean age: sixty-two years), the regional CBF (rCBF) was decreased significantly with a rise in the mean arterial blood pressure (MABP) in the cerebral cortexes (r = -0.575) and the deep gray matter (r = -0.451), whereas the regional cerebral metabolic rate for oxygen (rCMRO2) remained unchanged. In the brain infarct (BI) group (n = 22, mean age: fifty-eight years), however, the rCBF as well as the rCMRO2 were reduced even in the normotensive patients and thus did not correlate with the MABP. These results suggest that long-standing hypertension per se causes a reduction in the rCBF but not in the oxygen metabolism with a compensatory increase in the oxygen extraction fraction. On the other hand, patients with brain infarction, even normotensives, show a diffuse decrease in cerebral circulation and metabolism, which is probably due to the more severe sclerotic changes that take place in the cerebral vessels.

Blood Pressure↗

PubMed1995

[Urinary incontinence in elderly patients in the chronic stage of stroke].

One hundred and six elderly patients with chronic stroke who were admitted to Seiai Rehabilitation Hospital were studied regarding urinary incontinence. The average age of the subjects was 74 +/- 8 years old, ranging from 60 to 94 years. Seventy three of the 106 patients (69%) had urinary incontinence which was found in 72% of brain infarction, 61% of brain hemorrhage and 67% of subarachnoid hemorrhage. The prevalence of urinary incontinence in cases of brain stem, thalamic, and putaminal hemorrhage was 80%, 67% and 46%, while that in cases of cortical infarction and infarct of perforating arteries was 84% and 68%, respectively. The rate of urinary incontinence was significantly higher in those aged 75 years or over (p < 0.05), those with poor activities of daily living (ADL, p < 0.005), or with dementia (p < 0.001). Dementia was a complicating factor more frequently in aged patients (p < 0.05) and in those with poor ADL (p < 0.001), although no correlation was seen between age and ADL (p = 0.08). These results indicated the high prevalence of urinary incontinence in elderly inpatients with chronic stroke, which is significantly related to impairment of mental and physical activities.

Activities of Daily Living↗

PubMed1995

[A diabetic patient with bilateral carotid stenosis who developed neovascular glaucoma following cataract surgery].

A 67-year-old diabetic man suffered from right neovascular glaucoma following the ipsilateral cataract surgery. Three years later, he underwent left cataract surgery and again developed left neovascular glaucoma after the operation. Fluorescein angiogram showed a marked delay in retinal circulation. Moreover, severe stenosis of bilateral carotid origins and reflux of bilateral ophthalmic arteries were ascertained by neurosonographical examination such as duplex cervical echography and transcranial Doppler, as well as an angiogram. Brain imaging demonstrated asymptomatic watershed infarction in the left parieto-occipital cortex. Chronic ocular ischemia caused by carotid stenosis is one of the decisive risk factors for secondary glaucoma after cataract surgery. Preoperative neurosonographical screening tests are required to decrease ocular surgery complications, especially in the aged, and diabetic patients.

Aged↗

PubMed1994

Hypercoagulable state under low-intensity warfarin anticoagulation assessed with hemostatic markers in cardiac disorders.

The hemostatic condition under low-intensity anticoagulation in cardiac disorders is not fully elucidated. The aim of this study was to ascertain whether hemostatic molecular markers are a useful assessment for anticoagulation to detect the hypercoagulable state. A hematologic study was performed in 75 outpatients, without thromboembolic episodes, treated with low-intensity anticoagulation (average international normalized ratio [INR] 1.72) because of potential cardiac sources of arterial emboli, and in 40 age-matched control subjects. The average level of thrombin-antithrombin III complex (TAT) was significantly lower in patients than in control subjects (p = 0.005), and the mean value of D-dimer was not statistically different between patients and control subjects. Although TAT correlated moderately with D-dimer (r = 0.45, p = 0.0001), INR did not correlate with TAT or D-dimer. Elevated TAT > 3.0 ng/ml and/or D-dimer S 150 ng/ml were observed in 15 patients (20.0%), whereas the remaining 60 patients (80.0%) had no obvious increase in the level of TAT or D-dimer at overall INR. Antithrombin III activity did not correlate significantly with INR, but protein C activity and free protein S antigen showed a significant negative relation to INR (r = 0.82, r = 0.62, respectively, p = 0.0001). Low-intensity anticoagulation was sufficient to reduce coagulation and subsequent fibrinolytic activation in cardiac disorders, but may not be sufficient in some patients with elevated TAT or D-dimer concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III↗

PubMed1994

Inhibition of angiotensin-converting enzyme modulates the autoregulation of regional cerebral blood flow in hypertensive rats.

The inhibition of angiotensin-converting enzyme activities is considered to favorably modulate the hemodynamics of the brain. We designed the present study to examine the effects of angiotensin-converting enzyme inhibitors on regional differences in the lower limits of cerebral blood flow autoregulation in spontaneously hypertensive rats. Angiotensin-converting enzyme inhibitors (either 10 mg/kg captopril or SQ 29,852 in saline) were intravenously injected 15 minutes before hemorrhagic hypotension was induced. Cerebral blood flows to the parietal cortex and thalamus were simultaneously measured by hydrogen clearance. Both captopril and SQ 29,852 significantly decreased mean arterial pressure by 14 to 18 mm Hg and also reduced calculated cerebral vascular resistance by 11% to 15% of resting values, which resulted in a well-maintained cerebral blood flow. The lower limits of autoregulation were 76 +/- 2% (mean +/- SEM) and 77 +/- 2% of resting values in the cortex and thalamus, respectively, in control rats. Administration of either captopril or SQ 29,852 significantly reduced the lower limits to 65 +/- 3% (P < .01 versus control) and 67 +/- 2% (P < .05), respectively, in the cortex, which were slightly but always larger than the 71 +/- 3% and 71 +/- 2% reduction, respectively, in the thalamus. The inhibition of angiotensin-converting enzyme activities thus may be more protective against acute hypotension for cerebral microcirculation in the cortex than in the thalamus.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed1994

Pontine infarction extending to the basal surface.

BACKGROUND AND PURPOSE: Etiology and symptomatology in pontine infarction extending to the basal surface are supposed to be different from those in deep pontine infarction of the lacunar type. The aim of this study was to compare the infarct size and location, vascular lesions, risk factors, and neurological deficits in three different types of acute pontine infarction. METHODS: We studied isolated pontine infarction extending to the basal surface on brain imaging (group 1, n = 30), deep pontine infarction without extension to the basal surface (group 2, n = 23), and pontine infarction with simultaneous extrapontine infarct in the posterior circulatory system (group 3, n = 20). Clinical features, angiographic findings, and risk factors such as emboligenic heart disease, hypertension, and hypercholesterolemia were compared among the groups. RESULTS: The infarct area was 2.5 times greater in group 1 than in group 2. On angiogram, atherosclerotic stenosis of the basilar trunk was observed in 50% of the patients studied in group 1, in 0% in group 2, and in 78% in group 3. Emboligenic heart diseases were observed in 23%, 0%, and 30% in groups 1, 2, and 3, respectively. However, hypertension (60% to 65%), diabetes mellitus (35% to 45%), and hypercholesterolemia (13% to 17%) were equally distributed among the three groups. Classic lacunar syndromes were seen in 14 patients (47%) in group 1, in 20 patients (87%) in group 2, but in none of the patients in group 3. Patients belonging to group 1 showed a higher incidence of hemiparesis involving the face (37%), sensorimotor stroke (20%), and hemiparesis with confusion (17%) than those in group 2 (22%, 0%, and 4%, respectively) or in group 3 (0%, 5%, and 0%, respectively). CONCLUSIONS: Pontine infarction in group 1 may have several different causes, such as cardioembolism, artery-to-artery embolism, or atherosclerosis of the basilar artery affecting pontine branches. Severe neurological symptoms often result that differ from those seen in the deep pontine lacunar infarction in group 2.

Adult↗

PubMed1994

Relation of cerebral blood flow to motor and cognitive functions in chronic stroke patients.

BACKGROUND AND PURPOSE: The aim of this study was to examine the levels of cerebral blood flow in relation to motor and cognitive functions in 300 chronic unilateral stroke patients (age, 64 +/- 12 years; mean +/- SD). METHODS: Cerebral blood flow was measured by the 133Xe inhalation method, adjusted for age, sex, and PCO2 level. Motor function was scored according to Brunnstrom hemiplegic staging and cognitive function according to the Hasegawa dementia rating scale tested in Japanese. RESULTS: Asymmetries of blood flow between affected and nonaffected hemispheres increased with lesion size and were highest in 11 embolic strokes (20 +/- 9%) and higher in 80 nonembolic cortical infarctions (11 +/- 11%) and 76 hemorrhages (9 +/- 7%) than in the group of 133 subcortical infarctions (2 +/- 6%) or 16 control subjects (1 +/- 2%). Severity of hemiparesis correlated with decreased cerebral blood flow in the affected hemisphere (P < .01) and increased hemispheric asymmetries of blood flow (P < 001). Cognitive impairments, after adjusting for age, correlated with decreased cerebral blood flow in the nonaffected hemisphere (P < .0001), left hemispheric lesions (P < .0005), and embolic stroke (P < .005) but not with asymmetries of blood flow. Among 67 patients having bilateral reductions of cerebral blood flow, 25 patients with left hemispheric lesions showed more severe cognitive impairments than among 42 patients with right hemispheric lesions (P < .05). CONCLUSIONS: We confirmed that severity of hemiparesis correlated with the degree of asymmetries of cerebral blood flow, reflecting the extent and location of the lesions. Bilateral reductions of cerebral blood flow in patients with left hemispheric lesions may in part contribute to cognitive impairments, indicating reductions of global neuronal activities in the contralateral hemisphere or diffuse cerebrovascular changes. Further studies of cerebral metabolism and follow-up of cerebral circulation are required to reveal the pathophysiology and clinical consequences.

Adolescent↗

PubMed1994

Increase in extracranial atherosclerotic carotid lesions in patients with brain ischemia in Japan. An angiographic study.

BACKGROUND AND PURPOSE: Atherosclerotic lesions in the cerebral arteries are distributed heterogeneously among different races. Intracranial carotid lesions are reported to be more common than extracranial carotid lesions among Japanese people, which is in sharp contrast to the pattern of cerebral atherosclerosis in whites. However, several Japanese clinicians have the impression, which has yet to be clinically proven, that extracranial carotid diseases are recently increasing in number. METHODS: One hundred twenty-one patients who developed ischemic stroke and underwent angiography were examined in the study. Seventy were admitted to our clinic from 1963 to 1965 (early group); the remaining 51 patients were seen from 1989 to 1993 (recent group). Angiographic findings and vascular risk factors were compared between the two groups. RESULTS: Severe atherosclerotic lesions of the extracranial internal carotid arteries increased significantly during the ensuing 24 years between the end of the first period until the beginning of the second period (from 1965 to 1989), whereas lesions in the intracranial carotid system were similar between the two groups. Severe atherosclerosis in the extracranial internal carotid artery was more frequent in patients with diabetes mellitus, which proved to be the only risk factor that showed a temporal increase. CONCLUSIONS: The proportion of severe atherosclerosis in Japanese patients with brain ischemia has been increasing in the extracranial internal carotid artery, while that in the intracranial carotid system remains unchanged. Such a temporal change may be the result, at least in part, of an increase in the prevalence of diabetes mellitus.

Arteriosclerosis↗

PubMed1994

Cerebral hemodynamics in hypertensive patients compared with normotensive volunteers. A transcranial Doppler study.

BACKGROUND AND PURPOSE: The present study was designed to examine cerebral hemodynamics in early and chronic stages of hypertension using transcranial Doppler sonography. METHODS: Our study population consisted of 16 chronic hypertensive patients with chronic and small deep brain infarction, 10 young early-stage hypertensive subjects, and 16 young normotensive healthy volunteers. Using three-dimensional mapping techniques, we identified the M1 portion of the middle cerebral arteries and measured mean blood flow velocity, and we calculated the Gosling pulsatility index (PI), Fourier PI of the first harmonic (Fourier PI1), and cerebrovascular resistance. RESULTS: Mean blood flow velocity in the young hypertensive group was statistically higher (71.7 +/- 11.7 cm/s [mean +/- SD]) than among chronic hypertensive subjects (56.9 +/- 21.4 cm/s, P < .01) and normotensive subjects (63.2 +/- 11.8 cm/s, P < .05). Gosling PI presented a mirror image of mean blood flow velocity in both hypertensive and normotensive subjects. Chronic hypertensive subjects showed significantly higher Fourier PI1 (0.32 +/- 0.05) and cerebrovascular resistance (2.08 +/- 0.82 mm Hg/cm per second) than normotensive subjects (0.25 +/- 0.03 and 1.31 +/- 0.23 mm Hg/cm per second [P < .005], respectively) or early-stage hypertensive subjects (0.25 +/- 0.04 and 1.44 +/- 0.26 mm Hg/cm per second [P < .02], respectively). CONCLUSIONS: Early-stage hypertensive subjects demonstrated higher velocity, normal Fourier PI1, and near normal vascular resistance, whereas chronic hypertensive subjects showed near normal velocity, higher Fourier PI, and greater vascular resistance. Results may indicate different degrees of cerebral arteriopathy and arteriolopathy between early and late stages of hypertension.

Adult↗

PubMed1994

Multiple brain infarction and hemorrhage by nonbacterial thrombotic endocarditis in occult lung cancer--a case report.

A fifty-four-year-old woman died from multiple brain infarction and hemorrhage in the bilateral cerebrum, cerebellum, and brainstem, with renal infarction. She developed hematuria and transient blindness sixteen days before admission. Low-grade fever, heart murmur, and aortic valve vegetation on ultrasonic cardiography suggested infectious endocarditis. Autopsy study revealed occult adenocarcinoma in the lung and nonbacterial thrombotic endocarditis, but infective endocarditis was not histologically confirmed. The patient was considered to be a rare case of nonbacterial thrombotic endocarditis who developed multiple small infarctions mainly in the brainstem and cerebellum. Nonbacterial thrombotic endocarditis seems to be still an important disease as the embolic source, even if cryptic, of systemic thromboembolism.

Adenocarcinoma↗

PubMed1994

Cerebellar vermis bleeding in a patient with hemophilia A. A case report.

A seventeen-year-old man with hemophilia A developed nausea, vomiting, and unsteady gait after mild head trauma. Magnetic resonance imaging clearly demonstrated localized bleeding in cerebellar vermis. Quick administration of factor VIII concentrates prevented further extension of the bleeding and the patient completely recovered without neurologic impairment. In hemophiliac patients, careful evaluation of intracranial lesions is desired after head trauma even if they show only nonspecific symptoms.

Adolescent↗

PubMed1994

Brain hemorrhage in mixed connective tissue disease. A case report.

Mixed connective tissue disease (MCTD) uncommonly develops stroke, although collagen disease is an important condition for stroke. A nonhypertensive woman with MCTD developed massive putaminal hemorrhage. No obvious predisposing factors were revealed by clinical and pathologic examination. MCTD may contribute to the development of brain hemorrhage by some mechanism other than hypertension.

Cerebral Arterial Diseases↗

PubMed1994

Purulent meningitis after endoscopic injection sclerotherapy for esophageal varices.

A 57-year-old man with liver cirrhosis developed alpha-hemolytic streptococcal meningitis following endoscopic injection sclerotherapy for esophageal varices. Central nervous system infection is uncommon as a complication of sclerotherapy, however, when such an infection does develop, it is usually intractable. We therefore emphasize the importance of immediate antibiotic therapy right after the onset of inflammatory symptoms in order to prevent the development of undesired infectious complications following sclerotherapy.

Ampicillin↗

PubMed1994

Effect of aging on glucose tolerance in spontaneously hypertensive rats.

We studied the age-related changes of glucose tolerance in female spontaneously hypertensive rats (SHR) that did not become obese with aging. Oral glucose tolerance test was performed in young (3 months), middle-aged (6 to 11 months), and aged (26 months) SHR. Fasting plasma glucose was significantly lower in aged SHR than in young SHR. The increase in plasma glucose after glucose administration over fasting level was significantly higher in aged SHR than in middle-aged SHR, but did not differ between young and aged rats. Pancreatic islet size and pancreatic immunoreactive insulin content were similar between young and aged SHR. The present study demonstrated that glucose tolerance did not deteriorate in SHR with aging, while genetic hypertension persisted. This suggests that the persistence of hypertension per se may not affect glucose tolerance in SHR.

Aging↗

PubMed1994

[An adult case of basal encephalomeningocele with recurrent meningitis].

A 35-year-old man developed meningitis for the first time at the age of 23. Thereafter, he repeatedly suffered from meningitis for six times before he was admitted to our clinic. Each meningitis was preceded by upper respiratory infection. Chronic infection in the head and neck, fracture of the skull base, liquorrhea, Mollaret meningitis, and acquired immunodeficiency were all ruled out. Nasal fiberscope examination revealed a palpating white tumor in the left olfactory cleavage. Coronal CT scanning demonstrated encephalomeningocele at the left ethmoidal cavity. The encephalomeningocele was surgically repaired and the patient has been free from further meningitis. The causal relationship between the encephalomeningocele and recurrent meningitis was discussed.

Adult↗

PubMed1994

[A case of acute idiopathic pandysautonomia complicated with acute pancreatitis and liver injury].

A case of acute idiopathic pandysautonomia (AIPD) complicated with acute pancreatitis and liver injury was reported. A 43-year-old woman acutely developed abdominal pain, low grade fever, lymphoadenopathy and generalized erythema in May 1992. She was found to have autonomic dysfunctions, such as orthostatic hypotension, hypohidrosis, paralytic ileus and urinary retention. A systematic investigation of autonomic function revealed an impairment of both sympathetic and parasympathetic post-ganglionic nerves. Serum concentrations of amylase, lipase, elastase 1, and transaminase and amylase creatinine clearance ratio were elevated in the early stage of the disease. No significant serological findings for viral infections were detected to suggest any special etiology of the disease; the symptoms gradually improved, although incompletely, after several months from the onset. AIPD complicated with acute pancreatitis or liver injury is uncommon. A possible link between undetectable viral infection and AIPD was discussed.

Acute Disease↗

PubMed1994

[A case of Weber's syndrome due to gradual expansion of a basilar bifurcation aneurysm].

We report an 82-year-old female who developed Weber's syndrome following gradual expansion of a basilar bifurcation aneurysm. The patient first developed subarachnoid hemorrhage at the age of 78. Cerebral angiography showed an intracranial aneurysm of 1 cm diameter at the bifurcation of the basilar artery. Three years later, the patient was readmitted because both CT and MRI at that time revealed that the lumen of the aneurysm was filled with an organizing thrombus. On her third admission at the age of 82, the diameter of the aneurysm was expanded to 2.5 cm and Weber's syndrome had developed. On T2-weighted MRI, a central low-intensity area surrounded by a high-intensity zone were evident in the aneurysm, suggesting the formation of an organized or organizing thrombus. Repeated MRI examinations are useful for following the expansion of a thrombosed aneurysm.

Aged↗