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Biomedical subjects

T Sasano

Publications and source records attributed to T Sasano.

At least 37 records · Page 2Linked to original sources

Transient complete atrioventricular block provoked by ventricular pacing in a patient with nonsustained ventricular tachycardia.

A 75-year-old woman with complete left bundle branch block underwent electrophysiological study (EPS) to assess the conduction in the His-Purkinje conduction system and to further investigate the electrical instability in the ventricle, which was suggestive by the findings of nonsustained ventricular tachycardia in ambulatory monitoring. Transient complete atrioventricular (AV) block was provoked by ventricular pacing, and the intracardiac recordings proved that the site of AV block was distal to the His bundle. This phenomenon was not related to the rate or the duration of the ventricular pacing. The transient impairment of the conduction appeared to be due to the fatigue phenomenon in the His-Purkinje system.

Aged↗

New electrophysiologic features and catheter ablation of atrioventricular and atriofascicular accessory pathways: evidence of decremental conduction and the anatomic structure of the Mahaim pathway.

INTRODUCTION: Several modalities of catheter ablation have been proposed to eliminate Mahaim pathway conduction. However, limited research has been reported on the electrophysiologic nature of this pathway in its entity. METHODS AND RESULTS: In seven patients, electrophysiologic study was performed, and radiofrequency energy was applied to investigate the electrophysiologic clues for successful ablation. In all seven patients, the Mahaim pathway was diagnosed as a right-sided atriofascicular or atrioventricular pathway with decremental properties. In two patients, two different kinds of electrograms were recorded through the ablation catheter positioned at the Mahaim pathway location: one was suggestive of conduction over the decremental portion, demonstrating a dulled potential; and the other of nondecremental conduction, demonstrating a spiked potential. All but one of the Mahaim pathways were eliminated successfully at the atrial origin where the spiked Mahaim potential was recorded. Radiofrequency energy application was performed at the slow potential site resulting in failure to eliminate the conduction over the Mahaim pathway. Conduction block at the site between the slow and fast potential recording sites was provoked by intravenous administration of adenosine, concomitant with a decrease in the amplitude of the Mahaim potential. In one patient, the clinical arrhythmia was a sustained monomorphic ventricular tachycardia originating from the ventricular end of the Mahaim fiber. CONCLUSION: The identification of Mahaim spiked potentials may be the optimal method to permit their successful ablation. Detailed electrophysiologic assessment is indispensable for successful ablation of tachycardias associated with Mahaim fibers because tachycardias unassociated with Mahaim fibers can occur despite complete elimination of the Mahaim fiber.

Adolescent↗

Monitoring the local electrogram at the ablation site during radiofrequency application for common atrial flutter.

Recent studies have suggested that the attenuation of the local electrogram amplitude recorded from the ablation electrode during radiofrequency (RF) application predicts lesion growth. This study examined the time course of local electrogram amplitude during ongoing RF delivery in patients with common atrial flutter (AFl). In 71 patients with AFl. RF energy was applied to the anatomical isthmus. Termination of AFl was noted during 68 of 625 applications of RF energy. The changes in local atrial electrogram amplitude observed at all successful sites were analyzed. With increasing duration of the RF delivery, the electrogram amplitude decreased exponentially to reach a steady state within a mean duration of 17+/-3 sec, which was significantly longer than that of the steady-state temperature. The average decrease in the amplitude was 67+/-13%. In 16 patients in whom an increase in the power of RF energy had resulted in AFl termination, there was a dose-response relationship between the power and the amplitude decrease. The decrease in local electrogram amplitude appears to be a reliable marker for the efficacy of tissue heating and may be useful as an endpoint for individual applications. Local electrogram monitoring may offer an optimal energy strategy in AFl ablation.

Atrial Flutter↗

Improvement in gonadotropin secretion after corticosteroid therapy in a case of POEMS syndrome.

We report a case of POEMS syndrome with various endocrine dysfunctions. A 49-year-old man was admitted to our hospital for pretibial edema and general fatigue. He had weakness of the lower extremities, hepatomegaly, monoclonal protein (IgG-lambda type), impotence, pigmentation and hypertrichosis. Endocrinological examination revealed impaired glucose tolerance, primary hypothyroidism and hypogonadotropic hypogonadism. After three months of treatment with corticosteroids, he showed an improvement in gonadotropin secretion, but no considerable change in the secretion of the other hormones. To our knowledge, this is the first case that showed an improvement in gonadotropin secretion as a result of corticosteroid therapy in POEMS syndrome.

Gonadotropins↗

Radiofrequency ablation of tachyarrhythmias in patients with Ebstein's anomaly.

We performed radiofrequency catheter ablation in five patients associated with Ebstein's anomaly to cure their refractory tachyarrhythmias. The presenting arrhythmias were four cases of orthodromic circus movement tachycardia using accessory pathways as a requisite limb, including one case of a Mahaim fiber and one of atrial flutter of common variety. All accessory pathways, including the Mahaim fiber, were ablated by RF energy delivered through the catheter placed at the AV annulus rather than the displaced anatomical AV groove. Interestingly, the antegrade or retrograde conduction interval over these accessory pathways was relatively longer than that of usual accessory pathways, and the accessory pathway potential was fractionated in some cases. The location of the atrioventricular node was displaced from the usual position to the postero-inferior area of Koch's triangle in one case. The configuration of the flutter wave was larger than usual in height as well as in width. All tachyarrhythmias were cured by RF catheter ablation. In the case of RF catheter ablation for patients with Ebstein's anomaly, close attention is indispensable in order to accomplish it safely and successfully, because of the anatomical and functional differences peculiar to Ebstein's anomaly.

Cardiac Catheterization↗

Possible application of transmitted laser light for the assessment of human pulpal vitality.

The purpose of this study was to determine whether use of transmitted laser light would enable a better assessment of human pulpal vitality than back-scattered light does (LDF: laser Doppler flowmetry). The experiments were carried out on ten upper central incisors in six subjects aged 23-28 years; five of the teeth were vital with no restoration, and five were non-vital. For use with transmitted laser light, the fibers within the probe of a conventional LDF apparatus were used, one for transmitting light onto the buccal surface, the other for receiving it at the palatal surface of the same tooth. For LDF, the probe was fixed at the buccal surface. Blood flow was measured at three different locations on each experimental tooth: the incisal third, the center and the cervical third of the tooth crown. In non-vital teeth, 1) output signals with transmitted laser light all registered zero, and no oscillation could be seen in recordings from any location on the tooth, but 2) LDF signals were above zero, there were regular oscillations related to heart rate, and passive increases in blood flow (corresponding to blood pressure increases) were recorded from both the center and the cervical third of the tooth, indicating that LDF registered blood flow of non-pulpal origin. In vital teeth, LDF signals were significantly higher than in non-vital teeth at each location on the tooth. At the central site on vital teeth, the output signals for transmitted laser light were about twice those seen with LDF, and passive blood flow changes corresponding to blood pressure increases were more clearly observed. These results indicated that transmitted laser light would be useful for the assessment of tooth pulp vitality both because the blood flow signals did not include flow of non-pulpal origin, and because its output signals and response to blood flow changes were clear and could easily be monitored.

Dental Pulp↗

Direct evidence of parasympathetic vasodilatation in cat periodontal ligament.

Sympathetic regulation of periodontal ligament blood flow (PLBF) is well-attested; however, vasodilator responses mediated by parasympathetic nerve fibers have yet to be conclusively demonstrated in the periodontal ligament (PL). The present study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat PL. In our cats, the cervical sympathetic trunks were sectioned bilaterally prior to any stimulation in order to eliminate sympathetic effects on the vascular beds under study. Dynamic changes in PLBF, with mandibular lip blood flow (LBF) recorded for comparison, were investigated in cat mandibular canine teeth using laser Doppler flowmetry. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were electrically stimulated intracranially. Such stimulation caused blood flow to increase in the ipsilateral PL and lip, without an increase in systemic blood pressure. These vasodilator responses in the PL and lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilation via activation of parasympathetic vasodilator fibers. In contrast, although intracranial stimulation of the trigeminal nerve root also induced increases in both PLBF and LBF, these were unaffected by hexamethonium, but reduced by tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that parasympathetic vasodilator mechanisms do exist in feline PL.

Animals↗

Absence of parasympathetic vasodilatation in cat dental pulp.

The existence and nature of parasympathetic nerve fibers in the dental pulp have long been a subject for discussion; indeed, vasodilator responses mediated by such nerve fibers have yet to be conclusively demonstrated in the dental pulp. This study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat dental pulp. Dynamic changes in pulpal blood flow (PBF), with mandibular lip blood flow (LBF) recorded as a control, were investigated in cat mandibular canine teeth by means of laser Doppler velocimetry. Peripheral trigeminal afferents (see below) were stimulated electrically to confirm that somato-parasympathetic reflex vasodilatation could be induced. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were then stimulated intracranially. Electrical stimulation of trigeminal afferents (in the infraorbital nerve or the maxillary buccal gingiva) caused no change in PBF but did increase ipsilateral LBF. Neither facial nor glossopharyngeal nerve root stimulation caused a PBF increase, though both elicited increases in ipsilateral LBF. The vasodilator responses in the lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilatation via activation of parasympathetic vasodilator fibers. In contrast, intracranial stimulation of the trigeminal nerve root induced increases in both PBF and LBF which were reduced by pre-treatment with tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that a parasympathetic vasodilator mechanism is not present in feline dental pulp.

Animals↗

Axon reflex vasodilatation in cat dental pulp elicited by noxious stimulation of the gingiva.

Antidromic stimulation of sensory nerves has been shown to increase blood flow in the tissue they innervate. This study was designed to determine if antidromic vasomotor responses occur in feline dental pulp and if they are mediated by branched axons supplying both tooth pulp and gingiva. Dynamic changes in pulpal blood flow (PBF) elicited by electrical stimulation, pinching, heating, and capsaicin application to the gingivae were investigated in cat mandibular canine teeth by means of Laser Doppler Velocimetry. All inferior alveolar nerve bundles and the cervical sympathetic trunk had been previously sectioned to avoid the occurrence of brainstem reflexes, e.g., somato-autonomic vasomotor reflexes. Increases in PBF were observed in seven out of 12 cats when a restricted gingival area adjacent to the canine teeth was stimulated as described, but the increases were abolished after the sensitive gingival area was painted with lidocaine jelly, a surface anesthetic. These vasodilator responses, remarkably reduced following repeated application of 30 mM of capsaicin, are considered to be induced via antidromic activation of capsaicin-sensitive nociceptive nerve fibers, presumably by axon reflex mechanisms, suggesting that nerve terminals supplying the gingiva originate from parent axons which have collaterals that innervate the canine tooth pulp.

Animals↗

Properties of veratridine-modified single Na+ channels in guinea pig ventricular myocytes.

Modification of single Na+ channels by the alkaloid neurotoxin veratridine was investigated in guinea pig ventricular myocytes using the cell-attached configuration of the patch-clamp technique. Pipette application of veratridine (50 microM) induced long-lasting openings with two different single-channel conductances of 7.6 and 3.0 pS, in addition to normal type of short openings with a single-channel conductance of 16 pS. The veratridine-modified high- and low-conductance channels appeared commonly, and they could coexist with the normal one in the same patch. The open-time distributions for the high- and low-conductance channels could be fitted by a single exponential. The mean open time for the high- and low-conductance events ranged between 19.1 ms at -120 mV and 86.0 ms at -10 mV and between 4.5 ms at -120 mV and 16.2 ms at -10 mV, respectively. The closed-time distributions for the two conductance channels consisted of at least two components, and their values and voltage dependence were similar. External Ca2+ block resulted in an apparent reduction of unitary current amplitudes with a similar voltage dependence and affinity for Ca2+ in the high- and low-conductance channels. However, the low-conductance channel was more resistant to tetrodotoxin than the high one. The probability of simultaneous occurrence of the high and low events was equal to the product of the probabilities of occurrence of the high event times that of the low event. Furthermore, we observed modified channel openings after a normal opening for the two conductance channels and a modified one turning into a normal one for the high-conductance channel. It is concluded that veratridine induces the two different types of modified Na+ channels in cardiac myocytes and these are correlated with normal openings.

Animals↗

Importance of cervical muscles in galvanic body sway test.

Retro-auricular galvanic stimulation in Romberg's posture elicits body sway which consists of an initial response (IR) and a deviation response (DR). Generally, anodal stimulation of the right side elicits IR to the left and DR to the right. We measured the deviation response (VDR) in various conditions in normal subjects. There was no significant difference between mean VDR in the standing posture weighted on the left foot (0.49 +/- 0.17 cm) and on the right foot (0.39 +/- 0.20 cm). Stimulation in the squatting posture also elicited IR to the left and DR to the right. Stimulation of the right side produced DR backward and to the right in the condition of the head facing to the right, and forward and to the right in the condition of the head facing to the left. The same body sway response as the after galvanic stimulation was also induced by non-galvanic maneuvers like inclining the head or moving the finger. Anodal stimulation in the sitting posture elicited slight but apparent head inclination to the stimulated side. These results suggest that cervical muscles play an important role in the galvanic body sway test (GBST), viz. IR and DR seemed to be secondarily produced by changes in the muscular tension of the neck.

Adult↗

A case of delayed endolymphatic hydrops.

A 30-year-old male with delayed endolymphatic hydrops was given a sac operation. An intradural portion of the endolymphatic sac was resected and the epithelial surface was examined under a scanning electron microscope. The epithelium showed fibrous degeneration and disappearance of the epithelial cells. Pathogenesis of degeneration of the endolymphatic sac is discussed.

Adult↗

[Familial deafness showing hearing pattern of low-tone losses].

Clinical and electrocochleographic studies of low tone familial deafness were carried out in 19 patients of 10 families. These hearing impairments were characterized by an upward-sloping pure tone audiogram with 50dB to 60dB hearing threshold below 2000Hz and with normal or near-normal hearing threshold above this frequency. The type of inheritance in these families showed autosomal dominant mode and no associated malformation. In 7 patients, hearing tests were repeated, it was observed that hearing threshold was not elevated. The short increment sensitivity index (SISI) tests were positive suggesting a hair cell lesion in tested 7 patients. The caloric tests were normal in tested 3 patients. No abnormal internal ear configuration was found in both X-ray and high-resolution computed tomography. Twelve patients with these familial low tone deafness (FLTD), 19 patients with Ménière's disease, and 9 patients with low tone sudden deafness (LTSD) were studied using the transtympanic electrode technique of electrocochleography. All patients of FLTD showed normal negative summating potential (-SP) amplitude, and the cochlear microphonics (CM) showed a nearly same detection threshold as hearing level of the pure tone audiogram at 1 kHz and 0.5 kHz. The evidence suggested that the hearing impairment resulted from a localized abnormality of the cochlear apex, and without endolymphatic hydrops. On the other hand, patients with Ménière's disease and LTSD showed a high -SP amplitude and a satisfactory detection threshold of CM compared with hearing level of the pure tone audiogram. These findings suggest that both Ménière's disease and LTSD relate to endolymphatic hydrops.

Adolescent↗

The nervous control of gingival blood flow in cats.

The purpose of the present study was to investigate the nervous control of gingival blood flow in cats. Gingival blood flow was measured by laser Doppler flowmeter in 75 cats during electrical stimulation and cutting or ligation of the inferior alveolar nerve and cervical sympathetic nerve without sympathectomy or pretreatment with adrenoceptor blocking agents. Three different patterns of responses in gingival blood flow were observed following electrical stimulation of the inferior alveolar nerve in cats. In 45 cats there was an increase in blood flow, in 4 cats a decrease in blood flow, and in 7 cats a biphasic change consisting of an initial decrease and a successive increase in blood flow. The vasodilator effect was significantly reduced by pretreatment with (D-Pro2, D-Trp7.9)-substance P. tripelennamine, and methysergide. Pretreatment with cimetidine, atropine, hexamethonium, phentolamine, or propranolol had no effect on vasodilatation. The vasoconstrictor response was completely inhibited by pretreatment with phentolamine; in this case the vasodilator response appeared after stimulation of the inferior alveolar nerve. Ligation or cutting of the inferior alveolar nerve always elicited an increase in gingival blood flow. Cutting the cervical sympathetic nerve had no effect on gingival blood flow in 8 of 10 cats and caused an increase in gingival blood flow in 2 cats; however, electrical stimulation of the cervical sympathetic nerve always caused a decrease in gingival blood flow in the cats investigated. The present results suggest that cat gingival blood flow is controlled by sympathetic alpha-adrenergic fibers for vasoconstriction and by sensory fibers and mast cells for vasodilatation.

Animals↗