PubMed Health⌕ Search

Biomedical subjects

H Hishida

Publications and source records attributed to H Hishida.

At least 37 records · Page 2Linked to original sources
PubMed1998

National survey of the use of endomyocardial biopsy in Japan.

A national survey of endomyocardial biopsy procedures was conducted in Japan. Questionnaires were mailed to 852 institutions and statistical analysis of the 213 completed questionnaires (25.0% of the total) was performed. Cardiac biopsies were being performed at 134 of these institutions (62.9%), representing a 5.5-fold increase over 1980. A total of 19,964 cardiac biopsies have been performed in Japan. Specimens were obtained from the right ventricle at 113 institutions, and from the left ventricle at 76 centers. The Konno-Sakakibara bioptome was used at 32 institutions, whereas the long sheath method was used at 98 institutions. Sixty of the institutions (44.8%) had encountered ventricular wall perforation. The perforation rate of the two ventricles combined was 0.7% (147 of 19,964 cases), with a mortality rate of 0.05% (10 of 19,964 cases). Endomyocardial biopsy has become widespread in Japan, and its safety was ascertained by this national survey.

Adult↗
PubMed1998

[Relationship between mitral valve echo score and hemodynamic variables in patients with mitral stenosis].

Mitral valve echo score has been proposed as a predictor or of the outcome of balloon mitral valvotomy in patients with mitral stenosis. The relationship between mitral echo score and the hemodynamic variables was evaluated. In 41 patients with pure mitral stenosis (nine men and 32 women, aged 57.9 +/- 9.4 years), mitral echo score was estimated from two-dimensional echocardiographic findings, and mitral valve area was measured by planimetry on the two-dimensional short-axis view. Apex phonocardiography and continuous-wave Doppler echocardiographic recording of transmittral flow were simultaneously performed to measure left atrial/left ventricular mean transmittral pressure gradient, pressure half-time and (Q-1)-(2-OS) interval. Linear regression analysis revealed that both mitral echo score and mitral valve area were significantly correlated with mean transmittral gradient (r = 0.522, p = 0.0005 and r = -0.651, p < 0.0001, respectively), pressure half-time (r = 0.491, p < 0.005 and r = -0.757, p < 0.0001) and (Q-1)-(2-OS) interval (r = 0.551, p < 0.0005 and r = -0.487, p < 0.005, respectively). Mitral echo score has a significant correlation with hemodynamic variables, which were comparable to but slightly different from mitral valve area, in patients with mitral stenosis.

Adult↗
PubMed1997

Early detection of successful coronary reperfusion based on serum concentration of human heart-type cytoplasmic fatty acid-binding protein.

Both human heart-type cytoplasmic fatty acid-binding protein (H-FABPc) and myoglobin are low molecular weight proteins that are abundant in the cytoplasm of myocardial cells. Unlike myoglobin, H-FABPc content in the skeletal muscle is less than in cardiac muscle. To investigate the usefulness of the serum concentration of H-FABPc in the early detection of successful coronary reperfusion, we measured serum concentrations of H-FABPc and myoglobin in 45 patients with acute myocardial infarction treated with intracoronary thrombolysis or direct percutaneous transluminal coronary angioplasty. Coronary angiography was performed every 5 min for reperfusion therapy to identify the onset of reperfusion. Reperfusion, defined as a TIMI grade 2 or 3, was achieved within 60 min of the initiation of reperfusion therapy in 30 patients (the reperfused group), but was not achieved in 15 patients (the non-reperfused group). Blood samples were obtained before initiation of treatment and 15, 30 and 60 min after initiation of treatment in the non-reperfused group. In the reperfused group, samples were obtained before reperfusion and 15, 30 and 60 min after reperfusion. The H-FABPc ratio (the ratio of value after to value before the initiation of treatment or reperfusion) increased sharply after the onset of reperfusion, peaking at 41 +/- 18 min, and decreased rapidly thereafter. The predictive accuracy of an H-FABPc ratio of > 1.8 for the detection of reperfusion within 60 min of the initiation of treatment was 93% at 15 min after reperfusion, 98% at 30 min, and 100% at 60 min. Similar rates of predictive accuracy were observed for a myoglobin ratio > 2.4. The H-FABPc ratio detected successful reperfusion as early as 15 min after the onset of reperfusion and was highly accurate in detecting reperfusion within 60 min of the onset of reperfusion. The predictive accuracy of the H-FABPc ratio was similar to that of the myoglobin ratio for the early detection of successful coronary reperfusion.

Adult↗
PubMed1997

Feasibility of diagnosing chronic myocarditis by endomyocardial biopsy.

In studies of all the layers of autopsied hearts from patients with chronic myocarditis, local clusters of lymphocytes are frequently noted, in contrast with hearts obtained from patients with acute myocarditis. Myocardial biopsy specimens, however are no larger than about 2mm x 3mm. With this in mind, the present study was undertaken to determine whether chronic myocarditis can be diagnosed by endomyocardial biopsy. Specimens were obtained from seven patients in whom chronic myocarditis was confirmed by the clinical course and by autopsy findings. In H&E stained specimens, sites corresponding to the biopsy sites in both ventricles (right ventricular free wall, right ventricular side of the ventricular septum, left ventricular lateral wall) were selected at random (five sites each from the right and left ventricles in each patient) and examined under a light microscope. A mean of 5 or more lymphocytes per visual field (by light microscopy at 400-fold magnification), a proposed quantitative diagnostic criterion of myocarditis, was noted in the right ventricle in three patients (5 lymphocytes in two patients and 6 in one patient) and in the left ventricle in one patient (5 lymphocytes). Also, when the presence of lymphocyte clusters, considered to be a characteristic feature of chronic myocarditis, was determined, clusters of 20 or more lymphocytes per visual field were found in the same patients as those mentioned above, namely, in three patients (42.8%) in the right ventricle, as mentioned above, and in one patient (14.3%) in the left ventricle. At the sites of these lymphocyte clusters. findings such as degenerative changes of the myocardial cells and interstitial fibrosis were also associated, making possible a diagnosis of myocarditis. Therefore, in chronic myocarditis, even if five specimens are obtained by right ventricular biopsy, in approximately one half of patients the diagnosis of chronic myocarditis will be missed because of sampling errors.

Adolescent↗
PubMed1997

Total anomalous pulmonary vein drainage in an adult diagnosed by helical computed tomography.

A 41-year-old man visited our hospital with the complaint of palpitation by atrial flutter. He was finally diagnosed as total anomalous pulmonary vein drainage by helical computed tomography (CT). This case is very unusual due to the lack of symptoms until the age of 41. The absence of pulmonary artery stenosis, and the presence of atrial septal defect providing sufficient right to left shunt flow to maintain the output of left ventricle are some of the reasons to explain the lack of symptoms and very slight impact on daily life. Helical CT, in particular 3-dimensional imaging, is very useful in diagnosing complicated cardiovascular deformation as in this case.

Adult↗
PubMed1997

[Echocardiographic prediction of risk for embolism in patients with infective endocarditis].

The relationship between two-dimensional echocardiographic findings of vegetation and embolic events was investigated in 26 patients with infective endocarditis (17 males and 9 females, mean [+/-SD] age 51 +/- 17 years). The size and the other morphologic characteristics of vegetation (mobility, extent and consistency) were analyzed retrospectively according to the criteria by Sanfilippo, et al., and parameters were assigned scores from 1 to 4 to provide a total score. Patients with a maximum vegetation diameter > 10 min had a significantly higher incidence of embolic events than those with < or = 10 mm (p < 0.05). Each parameter of vegetation showed no significant difference between patients with and without embolic events; but the total score was significantly higher in patients with embolic events (p < 0.05). Particularly, all patients with a total score > or = 10 had embolic events, whereas those without embolic events had a total score < or = 9. There were no significant differences in the frequency of emergent valve replacement between patients with aortic value and mitral valve endocarditis. However, the incidence of heart failure was higher, but not significantly, in patients with aortic valve (67%) and combined valve endocarditis (67%) than in those with mitral valve endocarditis (36%). The maximum size and total score reflecting mobility, extent and consistency of vegetation using two-dimensional echocardiography provide useful information to predict the occurrence of embolic events in patients with infective endocarditis.

Adult↗
PubMed1997

Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction.

We compared the diagnostic utility of serum concentrations of human heart-type cytoplasmic fatty acid-binding protein (H-FABPc), myoglobin, and their ratio for the early diagnosis of acute myocardial infarction (AMI) in 104 healthy volunteers and 165 patients at admission within 6 h of the onset of chest pain. The ROC curves of the H-FABPc [0.946, 95% confidence interval (CI) = 0.913-0.979] and myoglobin (0.895, 95% CI = 0.846-0.944) between patients with AMI and healthy volunteers were significantly greater than the area under the ratio of myoglobin to H-FABPc (0.823, 95% CI = 0.765-0.881). In 165 patients, the sensitivity (81.8%, 95% CI = 74.2-89.4%), specificity (86.4%, 95% CI = 78.1-94.6%), and predictive accuracy (83.6%, 95% CI = 78.0-89.3%) of H-FABPc > 12 micrograms/L in diagnosing AMI were significantly higher than those of myoglobin, and were similar to those of the combination of H-FABPc > 12 micrograms/L and the ratio < or = 14. We conclude that H-FABPc is a more sensitive and specific marker than myoglobin for the early diagnosis of AMI, and that their ratio cannot give a clear advantage over the measurement of H-FABPc alone.

Adult↗
PubMed1997

Three-dimensional echocardiography by semi-automatic border detection in assessment of left ventricular volume and ejection fraction: comparison with magnetic resonance imaging.

The feasibility of three-dimensional echocardiographic reconstruction by semi-automatic border detection to assess left ventricular volume and function was investigated in a clinically applicable setting in 23 patients with various cardiac diseases and 7 normal volunteers. The commercial equipment permits digital acquisition of three apical orthogonal views, manual tracing of end-diastolic and end-systolic endocardium, semi-automatic border extractions of other frames, three-dimensional echocardiographic reconstruction and dynamic display within 20 min in a low resolution mode. Correlation of measurements with data obtained by magnetic resonance imaging (MRI) using the biplane modified Simpson method showed left ventricular end-diastolic volume (y = 0.894x - 0.456, r = 0.925, p < 0.001), end-systolic volume (y = 1.09x - 8.98, r = 0.959, p < 0.001), and ejection fraction (y = 0.956x + 1.93, r = 0.851, p < 0.001). In addition, a dynamic three-dimensional "movie-like" image displayed the shape, geometry, and regional wall motion abnormality, and change in global shape and size of the left ventricle. Three-dimensional echocardiographic analysis by three apical orthogonal views and dynamic display of the left ventricle provides reliable data comparable to MRI measurements within a reasonable period of time, and is now clinically feasible.

Adult↗
PubMed1997

[Comparison of effects of thrombolytic therapy followed by elective coronary intervention and direct coronary intervention in acute myocardial infarction: usefulness of dobutamine stress echocardiography].

The effects of intravenous administration of tissue plasminogen activator (t-PA) followed by elective percutaneous transluminal coronary angioplasty (PTCA) were compared to those of direct PTCA (d-PTCA) in patients with acute myocardial infarction using dobutamine stress echocardiography 1 week and 1 month after the acute episode. There were 12 patients in the t-PA group and nine patients in the d-PTCA group. Dobutamine was infused at incremental doses (5 micrograms/kg/min for each 5 min step). Wall motion changes were classified during infusion into four patterns, improvement, biphasic, worsening and no change. One week after the acute episode, seven of 12 patients in the t-PA group showed biphasic the pattern and five showed the improvement pattern. The biphasic pattern was observed in three patients in the d-PTCA group, worsening in one and improvement in five. One month later, the biphasic pattern in five patients in the t-PA group changed to the improvement pattern. No patients in the d-PTCA group showed changes in the wall motion pattern. There was no difference between the two groups in the frequency of the change of wall motion patterns 1 week and 1 month after infarction, but the improvement pattern was significantly increased from five to 10 patients in the t-PA group after 1 month (p < 0.05). The sensitivity, specificity and accuracy of the biphasic pattern in the t-PA group for indicating remnant coronary stenosis were 78%, 100% and 83%, respectively. Evaluation of wall motion pattern by dobutamine stress echocardiography is useful for assessment of reperfusion therapy for acute myocardial infarction. The administration of t-PA followed by elective PTCA has similar efficacy to d-PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1996

Is pre-intervention intravascular ultrasound necessary in evaluating target lesion calcification in patients undergoing transcatheter therapy?

To identify a subset of patients with a high probability of extensive calcification for further intravascular ultrasound (IVUS) examination, the frequency and extent of target lesion calcification as assessed by IVUS and its correlations with age, gender and risk factors as well as the value of angiography in identifying ultrasound calcification were analyzed in 88 patients undergoing balloon angioplasty for significant coronary atherosclerotic stenosis. The extent of calcification was semi-quantitatively graded as 0: no calcification; +: calcification arc < 90 degrees; ++: calcification arc from 90 degrees to 180 degrees; : calcification arc > 180 degrees. The distribution pattern of calcification was classified as superficial, deep or mixed. The results indicate: (1) the frequency of target lesion calcification was 38.6%, of which 52.9% showed a superficial pattern and 56.0% had a calcification arc < 90 degrees; and (2) only age was significantly associated with target lesion calcification in all of the patients. The frequency of calcification was remarkably higher in patients > or = 60 years old than in patients < or = 60 years old (61.9% vs 17.4%, p < 0.001); (3) among patients less than 60 years old, those with calcification had a higher average number of risk factors than those without; and (4) the total sensitivity of angiography in identifying ultrasound calcification was 43.6%, with a significantly higher sensitivity for calcification arc > 180 degrees and mixed pattern. In conclusion, pre-intervention IVUS may be necessary in patients > or = 60 years old and in those < 60 years old with more than two risk factors in selecting devices to optimize interventional strategies.

Age Factors↗
PubMed1996

Advantages and disadvantages of dobutamine stress echocardiography compared with treadmill exercise electrocardiography in detecting ischemia.

We compared the effectiveness and practicability of dobutamine stress echocardiography (DSE) and treadmill exercise electrocardiographic testing (TMT) for detecting coronary artery disease. Ninety-six patients (mean age 58.8 +/- 9.0 years) who presented for coronary angiography underwent both DSE and symptom-limited TMT. Two-dimensional echocardiography was performed to detect ischemia-induced wall motion abnormalities during incremental dobutamine infusion (5-40 micrograms/kg per min administered in 5 min steps). The sensitivity of detecting ischemia was 63% for TMT and 79% for DSE (p < 0.05); the specificity was 61% for TMT and 88% for DSE (p < 0.05). The accuracy of TMT was 63% and of DSE 82% (p < 0.01). In patients in whom both tests gave true-positive results, the maximum ST depression was evaluated during DSE and TMT (n = 31). The ST segment depressions detected by DSE were significantly smaller than those detected by TMT (0.04 +/- 0.04 mV vs 0.17 +/- 0.07 mV, p < 0.01), and 10 patients had no evidence of ST segment depression despite the presence of new wall motion abnormalities. DSE took significantly longer to perform than TMT (26.0 +/- 5.0 min vs 5.5 +/- 2.0 min, p < 0.01). Thus, DSE is more sensitive, specific and accurate than TMT in detecting coronary artery disease and can detect ischemia at an earlier stage. However, it takes longer to perform than TMT and thus may be less suitable for routine clinical use.

Adult↗
PubMed1996

Lumen and wall morphology of mild coronary dilatation assessed by in vivo intravascular ultrasound.

The in vivo features of the wall and lumen of mild coronary dilatation associated with atherosclerosis and the relationship with coronary ectasia were investigated by intravascular ultrasound (IVUS) imaging of 11 patients with angiographically-proven mild coronary dilatation. Maximal luminal diameter, thickness of the inner echogenic layer and echolucent zone, and frequency of calcification of the dilatation sites were compared with those of proximal adjacent normal sites. The results showed that : luminal diameter by angiography was significantly larger at the dilatation site and the ratio of dilatation/normal diameter was 1.27 +/- 0.07; the maximal luminal diameter of the dilatation site by IVUS was greater than that of the normal site (4.56 +/- 0.87 vs 3.94 +/- 0.61 mm, p< 0.01); the thickness of the inner echogenic layer and echolucent zone increased significantly at the dilatation site over the normal site (0.48 +/- 0.12 vs 0.17 +/- 0.14 mm and 0.53 +/- 0.17 vs 0.10 +/- 0.10 mm, p< 0.001, respectively); calcification occurred more frequently at the dilatation site (54.5% vs 9.1%, p< 0.05). The thickened inner echogenic layer and echolucent zone and a high frequency of calcification were observed by in vivo IVUS in the wall of angiographically-defined mild coronary dilatation lesions caused by atherosclerosis.

Calcinosis↗
PubMed1995

Transthoracic visualization of pulmonary thrombus that mimicked left atrial thrombus. A case report.

A forty-five-year-old woman with an unusual case of primary pulmonary hypertension is presented. She showed a progressive dilatation of the pulmonary arteries and pulmonary thrombus over twenty-one years. Transthoracic echocardiography showed the presence of pulmonary arterial thrombus that mimicked left atrial thrombus. However, when the transducer was rotated clockwise to obtain the short-axis view, a thrombus was observed in the right pulmonary artery with spontaneous echo contrast. Although the visualization of pulmonary arterial thrombus by echocardiography has been quite limited, it would be worthwhile since patients with primary pulmonary hypertension may have enlarged pulmonary arteries, as observed in the present case.

Diagnosis, Differential↗