Biomedical subjects
Publications and source records attributed to T Furuse.
There is no evidence in the literature that coronary artery spasm is induced by indocyanine green (ICG). In the present report, we describe 2 cases who developed chest pain with transient ST elevation on electrocardiograms after intravenous administration of ICG.
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In lead CM5, the Q-wave response to exercise has been reported as an effective index in predicting coronary artery disease (CAD) and CAD with left anterior descending (LAD) disease. The purpose of this study was to verify these findings when the Q wave was analyzed in lead CC5 in 135 patients. The sensitivity for abnormal ST depression was 77%, specificity 83% and predictive value 78%. The corresponding values for the abnormal Q-wave response (reduction or no change in Q-wave amplitude) were 70%, 61% and 59%. These differences (except sensitivity) were significant. When either a positive ST or Q-wave response was used, sensitivity, specificity and predictive value did not significantly increase compared with the ST segment alone. In addition, only 45% of normal subjects with false-positive ST depression had a normal Q-wave response (increase) and 57% of patients with false-negative ST responses had an abnormal Q-wave response. When a positive response for CAD with an LAD lesion and for multivessel CAD with LAD narrowing was defined as having a Q-wave reduction, the sensitivities were extremely low (15% and 17%), but both the specificities and the predictive values were 100%. Therefore, the Q-wave analysis in lead CC5 is no more sensitive for detecting CAD than the ST-segment response. However, when a decreased Q-wave amplitude is observed, multivessel CAD and LAD narrowing can be predicted.
The effects of 711389-S (0.1-10 mumol.litre-1) on membrane potentials and currents of rabbit sinoatrial node preparations were studied using a conventional double microelectrode voltage-clamp method. The agent 711389-S decreased the heart rate, the maximum rate of depolarisation, and the amplitude of the action potential and increased the action potential duration in a dose dependent manner. The slope of the diastolic depolarisation was also reduced. Of the current systems of sinoatrial node, 711389-S depressed the slow inward current (Isi), the potassium outward current (IK), and the hyperpolarisation activated current (Ih) dose dependently. The kinetics of IK were not altered significantly by the drug. It is concluded that 711389-S does not have an effect on a single current system but that the drug exerts a depressant effect on the electrical activity of the sinoatrial node.
A case of an aneurysm associated with four coronary artery fistulae originating from three vessels is reported. The patient, a 52-year-old woman, had chest heaviness and palpitations. Coronary arteriography revealed the four fistulae originating from three coronary vessels with an aneurysm draining into the left ventricle and the main pulmonary artery. The patient's symptoms were relieved after fistulectomy and the aneurysmectomy, suggesting that a coronary steal phenomenon through the fistulae was the cause of her symptoms. This case is of interest because of its rarity, since this is the first case report of an aneurysm associated with four coronary artery fistulae from three vessels.
A simple method is described for evaluating the potencies of catecholamines on the slow response of myocardium. Catecholamines depolarize guinea pig ventricular muscle cells exposed to the high K+ (27 mmol/l) Tyrode's solution containing 0.2 mmol/l Ba through an increase in slow channel conductance. Higher concentrations of catecholamines in addition induce spontaneous action potentials. This model was used to estimate and compare catecholamine potencies on myocardium. Catecholamine concentrations needed for depolarization alone or for depolarization plus automatic activity were taken as basis for comparison. The order of potency obtained by means of this new method was: l-isoproterenol greater than l-adrenaline greater than or equal to dl-noradrenaline greater than or equal to dobutamine greater than or equal to dopamine. This is similar to the order reported with other methods.
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Cardiac metastases have been reported increasingly partly because of the longevity of cancer patients, but its antemortem diagnosis is frequently missed. This is due to the nonspecific clinical manifestations or relative lack of characteristic signs which are masked by the underlying disease. This is a report of a 42-year-old man diagnosed as having a metastatic cardiac tumor by echocardiography, six months after operation for squamous cell carcinoma of the gall bladder. Echocardiography revealed abnormal structures in the regions of the posterior and lateral walls of the left ventricle and interventricular septum, suggesting metastatic tumors. The cytological findings of a fine-needle aspiration biopsy specimen were squamous cell carcinoma. The patient died of cardiac failure eight months after the echocardiographic diagnosis. At autopsy, the abnormal structures in the heart were identified as cardiac metastatic tumors from gall bladder cancer. Reports of cardiac metastasis of gall bladder cancer is very rare (0-3%). The myocardial metastasis may have a more serious prognostic importance than the primary neoplasm itself; thus, its definite diagnosis is mandatory.
Effect of 1-[3-isobutoxy-2-(benzylphenyl) amino]propyl pyrrolidine hydrochloride (bepridil), a new antianginal agent, on membrane potentials and membrane currents of sinoatrial node cells of rabbits was examined using conventional microelectrode and double microelectrode voltage clamp methods. Bepridil at a concentration of 10 mumol/l caused an increase in spontaneous cycle length, and a decrease in maximum rate of rise of the action potential and action potential amplitude. The rate of diastolic depolarization (phase 4) was also decreased by the drug. In the voltage clamp experiment, bepridil reduced both the slow inward current (Isi) and the hyperpolarization activated current (Ih), and increased the recovery time constant of Isi, whereas the time-dependent potassium current (IK) was not altered significantly. The major effect, however, was the reduction of Isi. These electrophysiological findings suggest that bepridil has a depressant effect on the electrical activity of sinoatrial node mainly by mediating the depression of slow channel.
A 42-year-old man with gall bladder cancer was given a pancreatoduodenectomy. Chest-roentgenograms revealed a prominence of the left cardiac silhouette 6 months after operation. Two months later, the patient developed exertional dyspnea and chest pain. A diagnosis of heart metastasis of gall bladder cancer was established by aspiration cytology. Intravenous administration of 5-FU and cis-DDDP proved ineffective in controlling the disease. The patient died 14 months after operation. An autopsy revealed metastasis to the left ventricle of the heart. This is the 6th such case of gallbladder cancer in the literature.
Tumor volume measurement using tumor-margin clipping radiography was performed for estimating tumor regression of eight pancreatic adenocarcinomas treated with intraoperative electron irradiation. Half of the tumors regressed exponentially from the first day of treatment, but the other half increased slightly within the first week, after which volume reduction occurred. The volume-halving time was calculated from the regression curve. A wide distribution of volume-halving times as well as initial tumor volumes was seen in all patients. No correlation was found between these variables, but the former correlated well with survival time (r2 = 0.80). This well-known technique may offer a chance to foresee the prognosis of the disease by determining the volume-halving time.
A 52-year-old woman with acute uveitis associated with ocular sarcoidosis developed complete atrioventricular block 22 months after the initial diagnosis was made. Cardiac sarcoidosis is a serious and, not infrequently, a fatal disease. Although it is difficult to establish the clinical diagnosis of cardiac sarcoidosis, a serial ECG is considered necessary in patients with any kind of sarcoidosis.
The effects of aprindine (1 X 10(-7) to 4 X 10(-6) M) were examined on membrane potential and current of rabbit sinoatrial node by means of conventional microelectrode and double microelectrode voltage clamp methods. Aprindine decreased, in a dose-dependent manner, the spontaneously firing frequency, the maximum rate of depolarization and the action potential amplitude, and prolonged the action potential duration at half-amplitude. The slope of the diastolic depolarization was also reduced by the drug. In the voltage clamp experiment, aprindine reduced the slow inward current (Isi), the time-dependent potassium current (Ik) and the hyperpolarization activated current (Ih). The recovery time constant of Isi was prolonged by aprindine, while the kinetics of Ik was not altered. It is indicated that aprindine does not have an effect on a specific conductance or a single current system, but that the drug exerts an inhibitory effect on the electrical activity of sinoatrial node.
Pyrithiamine-induced acute thiamine-deficient encephalopathy was produced in adult male Wistar rats. Twenty-four hours before the onset of neurological signs the brain showed no morphological abnormalities. Encephalopathic rats had symmetrical lesions of edematous necrosis localized in the thalamus, mammillary body, and pontine tegmentum. Biochemically, encephalopathic rats had brain thiamine levels less than 20% of controls. For the assay of the concentrations of adenosine triphosphate (ATP) and phosphocreatine, the brains were fixed using 5 KW microwave irradiation and were divided into four parts: cerebral cortex, diencephalon, lower brainstem, and cerebellum. In the lower brainstem of the encephalopathic rats ATP concentrations were 89.5% of normal controls. Phosphocreatine levels were lowered to 70% of controls in the diencephalon and to 75% in the lower brainstem. Total high energy phosphate levels were decreased to 89% of controls in the diencephalon and 91% in the lower brainstem before the onset of neurological signs and to 76% and 79%, respectively, after the onset. In the cerebral cortex and cerebellum high energy phosphates were not significantly reduced. Lower high energy phosphate levels and the distribution of edematous lesions were coincident in the brain. These findings suggest that a low energy state is closely related to the formation of edematous lesions in thiamine-deficient encephalopathy.
The important two-dimensional echocardiographic finding of dissecting aneurysm in the acute stage is characterized by the presence of an oscillating intimal flap which is thought to be of highly diagnostic value. This report describes about three cases with dissecting aneurysm in which an oscillating flap was transiently observed. In Case 1 (62-year-old female), an oscillating flap observed in the aortic arch seven hours after the onset was not detected three days later. A flap in Case 2 (65-year-old male) which had been present in the descending aorta three hours after the onset of illness disappeared two days later. In Case 3 (55-year-old male), only an intimal flap without fine oscillation was demonstrated in the abdominal aorta by echocardiography performed three days after the onset of illness. In the acute phase of dissection, the echocardiographic detection of an oscillating flap seems to depend on the time of the study after the attack.
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A 51-year-old woman was admitted to our hospital because of palpitation, dyspnea and anterior chest discomfort. She had had a heart murmur since childhood. On physical examination, a rough grade 6/6 ejection systolic murmur was maximally audible at the second left intercostal space with a systolic thrill. The chest X-ray film showed the cardiothoracic ratio of 54% and the electrocardiogram demonstrated right ventricular hypertrophy. Calcification of the tricuspid annulus was recognized by chest X-ray films (anteroposterior and lateral views), M-mode and cross-sectional echocardiograms and the computed tomogram (CT) of the chest. Cardiac catheterization revealed the presence of valvular pulmonary stenosis and atrial septal defect. These findings were confirmed by surgical operation. Since the first description of Paktovskii in 1960, nine cases of calcification of the tricuspid annulus were reported, but no case has been described in the Japanese literature. Contrary to the mitral annulus, the echocardiographic and computed tomographic features of the calcification of the tricuspid annulus has not been reported previously. In this paper, we reported a middle aged patient with circumferential calcification of the tricuspid annulus in association with severe pulmonary stenosis and atrial septal defect, and the features of the echocardiogram and CT images were illustrated.