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Biomedical subjects

H Gen

Publications and source records attributed to H Gen.

47 records · Page 3Linked to original sources
PubMed1991

Transient segmental asynergy of the left ventricle of patients with various clinical manifestations possibly unrelated to the coronary artery disease.

Eight cases of transient reversible segmental asynergy of the left ventricle thought not to be related to coronary artery lesions are reported. Three cases were associated with inflammatory reactions of unknown origin, and one each with lactic acidosis, abdominal surgery, hypoglycemia, tetanus and pneumonia. None of the patients had symptoms suggestive of ischemic heart disease before or after these episodes. Electrocardiograms before these episodes were all normal. Two-dimensional echocardiography was performed to evaluate abnormal electrocardiograms. Coronary angiography was performed in 4 of 8 cases and was normal in all 4 cases; 2 done as emergencies and 2 non-emergencies. Two ergonovine tests were negative. Left ventricular wall motion abnormalities, present mainly at the apex of the left ventricle, returned to normal in 1 to 4 weeks. Giant negative T waves in the chest leads during this recovery period were characteristic electrocardiographic features and normalized in 6 weeks on average. We believe that these episodes were not related to ischemia due to coronary artery disease, but to some metabolic humoral factors. An excellent prognosis can be expected if these abnormal metabolic circumstances can be resolved.

Aged↗
PubMed1991

Native valve infective endocarditis in adults--analysis of 32 consecutive cases over a ten-year period from 1980 to 1989.

Thirty-two patients with native valve infective endocarditis who presented over a 10-year period at our hospital were analyzed retrospectively. The presenting symptom was a persistent fever in 22 patients. In 30 patients, the New York Heart Association functional class was less than II before the development of endocarditis. Blood cultures were positive on all occasions in 24 out of 29 culture-positive patients. All of the viridans streptococci, accounting for 79% of the isolated pathogens, were highly susceptible to ampicillin. Treatment consisted of a 6 week course of antibiotics, usually ampicillin, at a dose of 12 grams/day. In 9 cases, we had to change or stop the antibiotics because of severe side effects. The longer the period before making a diagnosis, the more severe were the symptoms of congestive heart failure and the more frequent was the incidence of cerebral hemorrhage. To initiate treatment as early as possible, in order to minimize valve destruction and to reduce the risk of cerebral hemorrhage, serial blood cultures are recommended in patients with valvular heart disease or congenital heart disease and a persistent fever, with minimal cardiac symptoms.

Adult↗
PubMed1991

Progressive restrictive cardiomyopathy--a case report.

We present a case of restrictive cardiomyopathy which progressed over a 10 month period. A 69-year-old female was admitted because of acute inferior myocardial infarction; hemodynamically, she was in Forrester subset I. Cardiac catheterization performed 4 weeks post-infarction showed markedly increased left ventricular end-diastolic and pulmonary wedge pressures. Left ventricular ejection fraction was 66% with postero-basal akinesis and minimal mitral regurgitation. The right coronary artery was completely occluded with good collateral circulation from the intact left coronary artery. Doppler echocardiography 4 weeks post-infarction showed pseudo-normalization of the A/E ratio of peak mitral flow velocity in atrial systole (A) to peak mitral flow velocity in early diastole (E). Preload reduction by nitroglycerin increased the A wave. Ten months post-infarction, the patient was re-admitted due to congestive heart failure. The A/E ratio was unchanged, however the A wave no longer increased after the same dose of nitroglycerin. We have hypothesized that dehydration and/or the vigorous use of a nitrate, in the acute phase of myocardial infarction, masked an underlying restrictive cardiomyopathy which progressed in the 10 months post-infarction.

Blood Flow Velocity↗
PubMed1991

A case of unusual longevity of tetralogy of Fallot confirmed by cardiac catheterization.

We describe a 61-year-old woman with tetralogy of Fallot and dextrocardia with complete situs inversus. The functional status of this patient was New York Heart Association (NYHA) class II and the systemic blood pressure was 100/54 mmHg. The hematocrit was 54.4% and the arterial partial pressure of oxygen was 53 mmHg. On cardiac catheterization, both pulmonary valvular and infundibular stenoses were of equal severity and the aorta and main pulmonary artery were of equal size. We think that this patient has survived to this unusual age for tetralogy of Fallot because of unusually low systemic pressure and a proper balance between the ventricular septal defect and the pulmonary stenosis.

Cardiac Catheterization↗
PubMed1991

[Two cases of atrial septal defect diagnosed by two-dimensional Doppler echocardiography: comparison with other methods for detecting atrial septal defect].

We describe two cases of atrial septal defect(ASD) diagnosed by chance with two-dimensional Doppler echocardiography(2DD) which was carried out for another purpose. There were no findings characteristic of ASD such as systolic murmurs in the pulmonary area, incomplete right bundle branch block pattern on electrocardiograms, increased hilar shadow on chest films or increased right ventricular chamber diameter in two-dimensional echocardiography. However, the 2DD showed blood flow crossing through the atrial septum. Cardiac catheterization confirmed the presence of a small ASD. ASD diagnosed by 2DD alone without other classical characteristic signs of ASD indicates that the ASD is small and clinically insignificant as it is with Doppler valvular heart disease.

Adult↗
PubMed1990

Left ventricular filling pattern in congestive heart failure patients with normal sinus rhythm--a decreased ratio of peak mitral flow velocity in atrial systole relative to that in early diastole may reflect markedly increased left ventricular end-diastolic pressure.

The left ventricular filling pattern was studied by pulsed Doppler echocardiography in 13 congestive heart failure patients with normal sinus rhythm. The first study was done when congestive heart failure was present; the second after the signs and symptoms of congestive heart failure disappeared. In 12 of the 13 patients, the peak mitral flow velocity in atrial systole (PFVA) increased after the congestive heart failure disappeared (mean increase from 50.5 cm/sec to 74.8 cm/sec : p = 0.0001, paired t test), and the peak mitral flow velocity in early diastole (PFVE) decreased significantly in all 8 patients in whom secondary mitral regurgitation became less severe after improvement of congestive heart failure (mean decrease from 90.8 cm/sec to 52.0 cm/sec : p = 0.0001, paired t test). The ratio of PFVA to PFVE (PFVA/PFVE) increased in all cases after the congestive heart failure improved (mean increase from 0.59 to 1.33 : p = 0.0001, paired t test). The PFVA/PFVE is a simple index of left ventricular diastolic function. A PFVA/PFVE greater than one indicates disturbed left ventricular diastolic function. However, when the PFVA/PFVE is in a normal range for the patients' age ("pseudo-normalization") and is accompanied by impaired left ventricular systolic function in congestive heart failure, markedly increased left ventricular end-diastolic pressure must be considered.

Adult↗
PubMed1990

[A clinicopathological study of cervical intervertebral discs--Part 1: On histopathological findings].

In order to examine the aging process of the cervical intervertebral discs, a histopathological study was performed on 158 cervical discs obtained at autopsy from 37 individuals ranging in age from 3 months to 87 years. In the nucleus pulposus, degenerative changes consisting of myxomatous and slightly hyalinized degeneration were already seen in the specimens obtained from subjects in the third decade of life. Degenerative changes of the annulus fibrosus, however, tended to develop from the fourth decade of life, with myxomatous degeneration mainly in the anterior and hyalinized degeneration in the posterior annulus. The horizontal fissure of the annulus extending to its outer portion was seen more frequently in the posterior portion. In the cartilaginous plate of the vertebral body, fissure formation and degeneration became evident in the fifth decade of life. In contrast to the disc, repairing processes were observed in the cartilaginous plate. Spur formation at the corner of the vertebral body may be due to the degeneration of the outer layer of the disc leading to enchondral ossification.

Adolescent↗
PubMed1990

[A clinicopathological study of cervical intervertebral discs--Part 2: On morphological and roentgenologic findings].

One hundred and eleven cervical vertebral bodies and 153 cervical intervertebral discs obtained in 35 autopsy cases were studied first by plain roentgenograms, discography and CT discography (CTD), and then histologically. In addition to the above studies, morphological measurements of various parts of the disc were made. Following results were obtained: 1) The anterior portion of the disc tended to become thinner with aging than the middle and posterior portions, 2) The nucleus pulposus initially located slightly anterior to the middle portion of the disc tended to move gradually to the posterior portion of the disc with aging, 3) The antero-posterior diameter of the cartilaginous plate showed a gradual decrease with aging, 4) False-negative discography+ was observed more frequently in the anterior protrusion than in the posterior protrusion, 5) The false-positive discography+ was apparently often caused by the penetration of the contrast medium into the Luschka's joint, and 6) The osteophyte of the vertebral body may be formed by enchondral ossification triggered by disc degeneration according to the histological studies.

Adult↗
PubMed1990

[Congestive heart failure in the elderly: severe tricuspid regurgitation by two-dimensional Doppler echocardiography].

We studied five cases of atrial fibrillation in the elderly showing severely decreased exercise tolerance (NYHA III) and normal left ventricular function. There were no signs of classical tricuspid regurgitation. Both atria were enlarged and right ventricular sizes were shown by two-dimensional echocardiography to have mildly increased. Two-dimensional Doppler echocardiography revealed severe tricupid regurgitation but at a maximal velocity less than 2.3 m/sec, meaning that right ventricular pressure was not increased. Cardiac output (CO) and circulating blood volume (BV), measured by radiocardiography showed CO to have decreased and BV to have increased. No intracardiac shunt was detected. The cause of this decreased exercise tolerance in the group in our study is thought to be right ventricular dysfunction due to the aging process. This also occurs in a similar pattern in younger people who have arrhythmogenic right ventricular dysplasia (ARVD), Uhl's disease, or right ventricular dilated cardiomyopathy.

Aged↗
PubMed1989

Reversible left ventricular wall motion impairment caused by pheochromocytoma--a case report.

Excessive catecholamine levels can cause myocardial damage in experimental animals. Similar observations have been made in humans following autopsy for pheochromocytoma. However, whether catecholamine crises are reversible or not remains uncertain. We report here a case in which pheochromocytoma manifested as acute pulmonary edema during an operation. Serial echocardiograms revealed that the depressed motion of the left ventricular wall was reversed after tumor removal. The plasma catecholamine level was extraordinarily high during the episode of acute pulmonary edema, and it seems that catecholamines in high concentration can directly damage the myocardium.

Adrenal Gland Neoplasms↗