Prognostic significance of hydropericardia and pericardial friction rub in Q-wave acute myocardial infarction.
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Aged↗
Biomedical subjects
T Iwasaka
Publications and source records attributed to T Iwasaka.
Relationship between redistribution on exercise thallium-201 scintigraphy and repetitive ventricular premature beats in patients with recent myocardial infarction.
The relationship between myocardial ischemia detected by exercise thallium-201 scintigraphy and repetitive ventricular premature beats (VPBs) during ambulatory monitoring was evaluated in 57 patients with recent myocardial infarction. Multivariate analysis was performed to obtain the relatively important factor related to repetitive VPBs with the use of the following variables: age, redistribution, left ventricular ejection fraction, serum potassium and magnesium concentration, QRS score, left ventricular aneurysm, and the number of diseased vessels. Thirty-five patients had redistribution, but only three of them had repetitive VPBs during exercise testing. The average heart rate before 79% of 398 episodes of repetitive VPBs during ambulatory monitoring was in the range of 56 to 70/min. These data indicate that most of repetitive VPBs during ambulatory monitoring were not provoked by exercise-induced acute myocardial ischemia. However, redistribution was found to be an important factor associated with repetitive VPBs. The electrical abnormality relating to a substrate characterized by chronic reversible ischemia may explain the association between redistribution and repetitive VPBs.
Adult↗
Factors associated with atrial fibrillation in Q wave anterior myocardial infarction.
To elucidate the role of inflammatory and hemodynamic factors in the genesis of atrial fibrillation in acute myocardial infarction, 228 patients with a first Q wave anterior myocardial infarction were studied. Forty-nine patients had pericarditis (detection of pericardial rub by careful auscultation), and 36 patients had echocardiographically demonstrated hydropericardium (presence of pericardial effusion without pericardial rub). During the first 3 days after admission, transient episodes of atrial fibrillation were observed in 10 patients (20%) with pericarditis (group 1), 15 patients (42%) with hydropericardium (group 2), and 20 patients (14%) without pericarditis and hydropericardium (group 3). Although there was no significant difference in the incidence of atrial fibrillation between groups 1 and 3, patients in group 2 had a significantly higher incidence of atrial fibrillation than those in groups 1 and 3. Pulmonary capillary wedge pressure and the number of advanced asynergic segments were found to be the important factors discriminating the three groups by multivariate analysis. Therefore atrial fibrillation after acute Q wave anterior infarction was not related to the inflammatory infiltration involving the atria but to the increase in atrial pressure resulting from hemodynamic change caused by more extensive myocardial damage.
Atrial Fibrillation↗
Mixed venous oxygen saturation as a guide to tissue oxygenation and prognosis in patients with acute myocardial infarction.
The relation of mixed venous oxygen saturation and the cardiac index to tissue oxygenation and prognosis was investigated in 119 patients with acute myocardial infarction. There was a positive correlation between mixed venous oxygen saturation and the cardiac index in 97 survivors and 22 nonsurvivors, but a significantly lower mixed venous oxygen saturation level at the same level of cardiac index was observed in nonsurvivors compared with survivors. Results of multivariate analysis with mixed venous oxygen saturation and the cardiac index indicated that only mixed venous oxygen saturation was significantly related to survival and to hyperlactacidemia. Oxygen delivery to tissues declined significantly in nonsurvivors because of a lower cardiac index and a lower hemoglobin concentration in these patients than in survivors. However, at the same level of oxygen delivery to tissues, nonsurvivors had a significantly higher rate of oxygen consumption leading to a correspondingly greater decrease in mixed venous oxygen saturation, suggesting that a greater increase in oxygen demand was also observed in nonsurvivors than in survivors. Thus mixed venous oxygen saturation after acute myocardial infarction is a better predictor of hyperlactacidemia and survival than the cardiac index, and this may be associated with an increased oxygen demand and an impaired oxygen transport system in seriously ill patients.
Aged↗
Expression of ras oncogene product and EGF receptor in cervical squamous cell carcinomas and its relationship to lymph node involvement.
The expression of ras oncogene product p21 and epidermal growth factor (EGF) receptor was studied immunohistochemically in tissues obtained from 52 patients with squamous cell carcinoma of the uterine cervix. We examined the relationship between p21 and EGF receptor expression and lymph node metastasis in cervical cancer. The data demonstrate that the patients with positive staining for ras p21 in cervical carcinomas have a higher incidence of lymph node metastasis than the patients with negative staining for p21 (P = 0.027). Although the levels of p21 expression in the metastatic sites were reduced compared to those in the primary sites, tumor cells in metastatic lymph nodes also expressed p21. No relationship was found between EGF receptor expression and lymph node metastasis. These results suggest that expression of ras oncogene product may be associated with the biological aggressiveness of cervical carcinomas.
Carcinoma, Squamous Cell↗
Antitumor effects of human recombinant interferon-gamma and tumor necrosis factor on five cervical adenocarcinoma cell lines, in vivo and in vitro.
We examined the antitumor effects of recombinant interferon-gamma (IFN-gamma) and tumor necrosis factor (TNF) on cervical adenocarcinoma cell lines, in vitro and in vivo. Four of five cell lines showed a high sensitivity to IFN-gamma, in vitro. One of five cell lines showed a remarkable sensitivity to TNF, in vitro. Only one cell line resistant to both IFN and TNF was derived from a well-differentiated adenocarcinoma of endocervical type. Experiments using nude mice bearing transplanted tumors revealed that these cytokines were also effective against tumors in vivo. All these observations suggest that IFN-gamma or TNF can have positive effects in the treatment of patients with adenocarcinoma of the uterine cervix.
Adenocarcinoma↗
Evaluation of preload reserve during isometric exercise testing in patients with old myocardial infarction: Doppler echocardiographic study.
To estimate the preload reserve in response to an increase in afterload in patients with old myocardial infarction, the relation between the Doppler echocardiographic inflow velocity pattern and left ventricular end-diastolic pressure was investigated during isometric handgrip exercise testing. The study population consisted of 16 normal subjects and 40 patients with old myocardial infarction. The 40 patients were subdivided into two groups according to left ventricular end-diastolic pressure at rest: group I (22 patients), less than 18 mm Hg; group II (18 patients), 18 mm Hg or more. At rest, the ratio of peak velocity in atrial contraction phase to peak velocity in early diastolic filling phase (A/E) was significantly higher in the patients with old myocardial infarction than in normal subjects; values in the two subgroups of myocardial infarction did not differ significantly. The A/E ratio and left ventricular end-diastolic pressure increased significantly during exercise in group I. Conversely, the change in left ventricular end-diastolic pressure during exercise in group II was significantly greater than that in group I, and was associated with a decrease in the A/E ratio. Thus, an atrial compensatory mechanism operated effectively in response to the increase in afterload in patients with a normal left ventricular filling pressure, whereas this compensatory mechanism deteriorated in patients with elevated left ventricular filling pressure due to a limited preload reserve.
Blood Flow Velocity↗
Increased extravascular lung water in patients with low pulmonary artery occlusion pressure after acute myocardial infarction.
OBJECTIVE: To evaluate the clinical characteristics of increased extravascular lung water (EVLW) in patients with low pulmonary artery occlusion pressure (PAOP) in the early phase of acute myocardial infarction. DESIGN: Consecutive sample for descriptions of the clinical features of medical disorders. SETTING: A general medicine group practice in a university hospital. PATIENTS: Sixteen patients with low PAOP (less than 18 mm Hg) on the initial measurement obtained within 12 hr of chest pain onset. MEASUREMENTS AND MAIN RESULTS: EVLW was measured by the thermal indocyanine green dye double-indicator dilution method. QRS score was obtained on hospital day 7 from the Selvester's QRS Scoring System. Eleven (69%) patients had increased EVLW greater than 7 mL/kg despite low PAOP. EVLW had no significant correlation with PAOP and the difference between plasma colloid osmotic pressure and PAOP, but did have a significant correlation with pulmonary vascular resistance index (r2 = .31, p less than .05), and QRS score (r2 = .45, p less than .005). CONCLUSIONS: Larger infarcts led to increased EVLW even with low PAOP, and the accumulation of increased EVLW around the small arterioles might have led to increased pulmonary vascular resistance.
Blood Pressure↗
Left ventricular dysfunction during dynamic exercise in noninsulin-dependent diabetic patients with retinopathy.
Systolic time intervals were obtained from 19 middle-aged noninsulin-dependent diabetic patients without clinically evident cardiovascular disease (8 patients had and 11 did not have retinopathy) and 14 normal subjects using ear densitography. All subjects had neither ischemic electrocardiographic response nor chest pain during maximal treadmill exercise. Although left ventricular ejection time (LVET) and preejection period (PEP) did not differ significantly at rest between the three groups, a prolongation of LVET with a nearly identical PEP response was observed during exercise in diabetic patients with retinopathy. These data indicate that the diabetic patients with retinopathy relied on the enhanced ventricular filling in maintaining stroke volume during exercise. Thus, retinopathy is associated with impaired left ventricular systolic function in noninsulin-dependent diabetic patients.
Diabetes Mellitus, Type 2↗
Pulmonary gas exchange in acute myocardial infarction with low pulmonary capillary wedge pressure.
To evaluate the clinical characteristic of pulmonary gas exchange in patients with low pulmonary capillary wedge pressure (PCW less than 18 mmHg) in the early phase of acute myocardial infarction, we investigated 48 patients admitted within 24h from the onset of chest pain. The alveolar-arterial oxygen tension difference (AaDO2) and arterial blood gas parameters were obtained while breathing room air on admission. The disturbance of pulmonary gas exchange, as revealed by the high value of AaDO2, existed without left ventricular dysfunction, and AaDO2 had no significant relationship with any of the hemodynamic parameters including the difference between plasma colloid osmotic pressure and PCW. Multiple regression analysis was performed using 9 variables related to pulmonary gas exchange, to identify those which were important. As a result, QRS score (p less than 0.01) and age (p less than 0.05) were identified as significant variables related to AaDO2. Thus, the disturbance of pulmonary gas exchange in patients with low PCW was caused by mechanisms other than left ventricular failure which may reflect the extent of ischemic myocardium.
Aged↗
Clinical significance of pericardial rub with regional ventricular dilatation.
To elucidate the clinical characteristics associated with regional ventricular dilatation in the early phase of myocardial infarction (MI), 228 patients with acute Q-wave anterior MI were studied. Forty-nine patients (21 percent) had echocardiographically demonstrated regional ventricular dilatation (an abnormal bulge in the left ventricular contour during both systole and diastole) on the third hospital day. Careful auscultation revealed that a pericardial rub was present in 49 patients (21 patients with and 28 patients without regional ventricular dilatation) during the first three days after hospital admission. Multivariate analysis was performed to determine the relative importance of pericardial rub with six other clinical variables related to regional ventricular dilatation. Pericardial rub and cardiac output were the significant factors related to the presence of regional ventricular dilatation. Thus, a pericardial rub, in concert with impaired left ventricular function, is a physical sign associated with regional ventricular dilatation, and anatomically transmural infarction is the possible factor explaining their association.
Aged↗
Diastolic time in diabetes. Impairment of diastolic time during dynamic exercise in type 2 diabetes with retinopathy.
To evaluate the effect of microangiopathic complications and autonomic dysfunction on diastolic time (DT) during dynamic exercise, 19 patients with type 2 diabetes and ten normal subjects were studied using ear densitography. All subjects had neither an ischemic electrocardiographic response nor chest pain during maximal treadmill exercise. The DT and heart rate (HR) had an inverse nonlinear relation, and electromechanical systole (QS2) and HR had an inverse linear relation during exercise. When the exercise DT-HR and QS2-HR relations were compared, a significant lengthening of QS2, with a consequent shortening of DT, was observed in diabetic patients with retinopathy, compared to patients without retinopathy and normal subjects (p less than 0.005), while no significant differences were found between diabetic patients without retinopathy and normal subjects; however, there were no significant differences in the exercise DT-HR and QS2-HR relations among diabetic patients with and without autonomic dysfunction and normal subjects. A more prominent abbreviation in the diastolic perfusion time observed in patients with retinopathy would be meaningful because microangiopathy might already have limited subendocardial blood flow. Thus, patients with type 2 diabetes who have retinopathy have a potential risk of aggravation of left ventricular function through the deterioration of myocardial blood flow.
Autonomic Nervous System Diseases↗
Doppler echocardiographic assessment of prosthetic aortic valve function. Findings in normal valves.
To determine the Doppler-derived aortic flow velocity profiles in relation to type of prosthetic valve and left ventricular function, 70 patients with normal functioning aortic prosthetic valves (group 1 = 44 patients with low-profile mechanical valves and group 2 = 26 patients with high-profile mechanical valves) were evaluated. Peak flow velocity and mean systolic gradient were inversely related to valve size (r = -0.72; r = -0.76) in group 1. On the other hand, aortic flow velocity profiles had significant correlations with left ventricular end-systolic dimension (r = 0.75; r = 0.76) and left ventricular fractional shortening (r = -0.69; r = -0.66) in group 2. Thus, aortic flow velocity profiles in the low-profile mechanical valve were affected by pressure gradient caused by the valve size, whereas the hydromechanical disadvantage of the high profile mechanical valve affected the left ventricular pump function and Doppler-derived flow velocity profiles.
Aortic Valve↗
[Frequency of complications of mitral valve prolapse in the elderly].
To evaluate the difference in the frequency of complication of mitral valve prolapse (MVP) according to sex in subjects aged 60 years and older, 543 patients (218 men and 325 women) who were diagnosed as having MVP by echocardiography at the Lahey Clinic Medical Center were studied. Three hundred and fourty eight patients had no complication of MVP (male vs female = 129:219). Infective endocarditis occurred in 20 patients (male vs female = 13:7). Rupture of chordae tendineae occurred spontaneously in 29 patients (male vs female = 20:9) and were associated with infective endocarditis in 8 other patients (male vs female = 6:2). Eighteen patients required mitral valve surgery for severe mitral regurgitation. The frequencies of these complications were higher in males than those in females. Cerebral ischemic events were encountered in 54 patients. There was no significant difference in the frequency between male and female. In conclusion, MVP in elderly men might be at for cardiac complication.
Aged↗
[Radionuclide assessment of left ventricular diastolic function in patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy; use of list mode method in patients with atrial fibrillation].
To evaluate the effect of percutaneous transvenous mitral commissurotomy (PTMC), equilibrium radionuclide angiocardiography was performed in eight patients with mitral stenosis who had atrial fibrillation. Accurate cardiac function in patients with atrial fibrillation is difficult to assess, since the wide fluctuation of cardiac cycle makes the ventricular hemodynamics variable. A new processing algorithm was devised to make multiple gated images discriminated from a heart rate distribution histogram. We obtained about 1,000 beats data by list mode acquisition, and processed a heart rate distribution histogram. The data in the area +/- 5% of the most frequent heart rate were converted into frame mode and a representative time activity curve was derived. Mitral valve area calculated by echocardiography increased from 1.3 +/- 0.5 to 2.0 +/- 0.6 (cm2) significantly (p less than 0.01). The mean transmitral pressure gradient measured by catheterization decreased from 12.4 +/- 5.9 to 4.9 +/- 3.7 (mmHg) significantly (p less than 0.01) and the clinical symptoms improved in all patients. The change in left ventricular ejection fraction from 43 +/- 9 to 48 +/- 13 (%) was not statistically significant, but peak filling rate (PFR) derived from the time activity curve increased from 1.5 +/- 0.3 to 2.0 +/- 0.4 (EDV/sec) significantly (p less than 0.01). Thus PFR is a noninvasive parameter that can evaluate the effect of PTMC.
Adult↗
Clinical significance of pericardial rub in inferior wall Q-wave acute myocardial infarction.
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Aged↗
[The clinical significance of serum sialyl SSEA-1 antigen in obstetrical and gynecological patients].
To evaluate the clinical significance of serum SSEA-1 level, the antigen level was measured in sera of obstetric and gynecologic patients. A positive rate was low in patients with endometriosis (9.1%), myoma uteri (0%), benign ovarian tumor (15%), cervical squamous cell carcinoma (14%) and endometrial carcinoma (18%). In this series of study, interest was that positive cases in benign ovarian tumor group were all patients with dermoid cyst. On the other hand, a high positive rate was observed among the patients with cervical adenocarcinoma (50%), primary ovarian malignancies (55%) and secondary ovarian malignancies (50%). Among the patients with ovarian malignancies, serum sialyl SSEA-1 level significantly increased according to clinical stage. In patients with positive serum sialyl SSEA-1, rising or falling of the serum level of this antigen correlated well with progression or regression of the disease. Measurement of serum CA125 was also performed in patients with ovarian malignancies, which showed a significantly higher positive rate (96%) and revealed that this antigen has no correlation with sialyl SSEA-1. A low positive rate of serum sialyl SSEA-1 level (9.1%) was observed in gravidas, while a higher positive rate (43%) in puerperas, especially within three days after parturition. This evidence should be considered when serum sialyl SSEA-1 antigen is measured as tumor marker. All these observations suggest that the measurement of serum sialyl SSEA-1 level is useful not only in the diagnosis of ovarian malignancies but for the judgment of the effect of treatment and the search for their recurrences.
Antigens, Neoplasm↗
Interferon gamma treatment for cervical intraepithelial neoplasia.
Eight patients with cervical intraepithelial neoplasia (CIN) were administered perilesional injections of human recombinant interferon gamma (IFN-gamma), and the response was evaluated by colposcopy and exfoliative cytology and then by histopathology. In all patients, colposcopic and cytologic findings improved after two to four injections of IFN-gamma and the cytologic findings reverted to normal in five of these eight patients. All five were free of dysplastic lesions. The other three patients with positive cytology and positive colposcopy after completion of IFN-gamma treatment underwent hysterectomy or laser conization, and histopathologic examination revealed residual dysplastic lesions. On the other hand, a control study revealed that only one of eight patients showed spontaneous regression during the 3-month observation period. During the course of these treatments, keratinizing cells were often present in the cervical smears and isolated cell keratinization was often evident in the residual dysplastic lesions of the surgical specimens. These observations suggest that IFN-gamma treatment is an effective therapeutic method for CIN lesions and that IFN-gamma has the potential to differentiate nonkeratinizing squamous cells into keratinizing cells.
Adult↗