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Biomedical subjects

H Kishida

Publications and source records attributed to H Kishida.

At least 91 records · Page 5Linked to original sources

Isolation of human chromosome 21-specific cosmids and their uses in mapping of cosmid contigs on chromosomal subregions.

A cosmid library of 3 x 10(5) clones has been constructed from a human x hamster hybrid cell line, 153E9a3, which contains human chromosome 21 (HC21) as the only human chromosome. From 56,500 clones of this library, 229 HC21-specific cosmids have been isolated by their hybridization to total human DNA and by their failure to hybridize to total Chinese hamster DNA. The cosmids isolated were then characterized, of these, 28 cosmids (12.2% of those tested) contained Not1 site(s), and 41 cosmids were localized on the eight subregions of HC21 by differential hybridization with Alu-PCR products obtained from a hybrid mapping panel. The cosmids localized were further integrated into the existing contigs using the end-specific probes of the clone insert. Therefore, they provided useful anchor points for contig mapping and walking.

Animals↗

Clinical significance of coronary artery calcification.

Coronary artery calcification (CAC) was easily demonstrated by plain CT-scan. The aim of this study was to clarify the clinical significance of CAC in cardiovascular diseases. The subjects were 90 patients with ischemic heart disease (30 myocardial infarction, 50 exertional angina pectoris and 10 variant form of angina pectoris; 46 males and 44 females, 68 +/- 10 y/o) and 50 patients without ischemic heart diseases (30 hypertension, 10 arrhythmia, 3 valvular disease, 2 cardiomyopathy, 2 congenital heart disease and 3 others; 25 males and 25 females 65 +/- 9 y/o). CAC and calcification of thoracic aorta were evaluated by plain CT-scan (1 second scan time and 5 mm slice). The relationship between CAC and other clinical features (age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking, resting ECG, exercise stress ECG, aortic calcification and optic fundi) were studied. CAC were seen more frequently in patients with ischemic heart disease (63%), old age (67%), aortic calcification (70%) and positive exercise testing (64%). On the other hand, CAC were rare in variant angina (30%). In younger patients (under 70 y/o), CAC were seen more frequently in diabetic patients. But, in older patients, CAC were frequently in those with hyperlipidemia. These results suggested that CAC was associated with not only systemic arteriosclerosis, but also ischemic heart disease, except vasospastic angina. The prognostic value of CAC would be studied later.

Age Factors↗

Unusual inferior vena cava obstruction causing extensive thrombosis: an intravascular endoscopic observation.

A 28-year-old, previously healthy man was referred to our hospital three months after the appearance of lumbago, leg pains and fever. Routine examinations were normal. Phlebography demonstrated occlusion of the common femoral veins by thrombosis. Inferior vena cavography and magnetic resonance image showed that the inferior vena cava (IVC) became gradually narrower from the level of 11th thoracic vertebra. An intravascular endoscopic study gave the same morphological findings; the endothelial surface was found to be intact. We concluded that the stenosis of the IVC was the primary lesion and was the essential pathological condition. The massive thrombosis appeared to have occurred secondarily.

Adult↗

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing--a randomized crossover study in comparison with placebo.

With eight cases of stable exertional angina as subjects, the antianginal action and sustained effects of single 10 mg oral doses of new calcium antagonists amlodipine were assessed by treadmill exercise tests in randomized crossover trials with respect to a placebo. Exercise tests were conducted before as well as 4, 8, and 24 hours after administration, and plasma amlodipine concentration was investigated at the same times. The maximal exercise time was 299 +/- 43 seconds before as compared with 346 +/- 49 seconds 4 hours after administration and 368 +/- 50 seconds 8 hours after administration, a significant prolongation in each case (p < 0.01). Moreover, the exercise time elapsed until 1 mm of ST-segment depression, as well as the ST-segment depression measured at the same time, were both significantly improved as compared with the placebo results. The plasma amlodipine concentration reached a peak 8 hours after administration and displayed an effective level even 24 hours after administration. The value of delta PRP measured at the same time during the exercise test was also significantly reduced as compared with the placebo results, even 24 hours after administration of amlodipine. These findings supported the conclusion that single 10-mg doses of amlodipine provide stable antianginal action over a 24-hour period.

Administration, Oral↗

Circadian variation of ischemic threshold in patients with chronic stable angina.

Circadian variation of ischemic threshold in chronic stable exertional angina was determined in 51 patients with documented coronary artery disease from the Holter monitor results. The peak favored time zones of ischemic attacks were 8 a.m. and 9 a.m. There was no difference in frequency of ischemic attacks, magnitude of ST-segment depression, or duration of ST-segment depression between the two time zones for ischemic attacks, 6-9 a.m. and 0-3 p.m., but the ischemic threshold was lower in the morning than in the afternoon. These observations suggest that the pathogenesis of ischemic attacks differs from one time zone to the other and is considered helpful in planning therapeutic strategies for myocardial ischemia.

Activities of Daily Living↗

Two cases of variant form angina pectoris associated with myocardial bridge--a possible relationship among coronary vasospasm, atherosclerosis and myocardial bridge.

Myocardial bridge (MB) is a congenital anomaly of the coronary artery and may occur in 5 to 12% of the human population. However, the mechanism of MB-induced myocardial ischemia is still speculative. We report 2 cases of variant form angina pectoris associated with MB in which myocardial ischemia seemed to be related to the interaction between coronary perfusion and MB. In case 1, electrocardiography during anginal attack at rest showed ST elevation in the inferior leads and MB was observed after percutaneous transluminal coronary angioplasty at the site of the right coronary artery lesion following successful dilatation. In case 2, MB of the left anterior descending coronary was located in the identical portion where coronary vasospasm was induced by intracoronary acetylcholine injection, although ischemia during the spontaneous anginal attack was limited to the inferior area of myocardium. These 2 cases suggest that MB can be, at least in some patients, one of the possible causes of the endothelial damage which seems to be related to coronary vasospasm; this was documented in both cases.

Angina Pectoris, Variant↗

Cardiac events in patients with silent myocardial ischemia.

The clinical implications of silent myocardial ischemic (SMI) episodes in patients with coronary artery disease were assessed in 253 patients whose angina symptoms were resolved by antianginal drugs. This population included 93 patients without a history of myocardial infarction (angina group) and 160 patients with myocardial infarction (infarction group). These patients were further divided into 2 subgroups according to whether or not SMI was detected by Holter monitoring immediately before discharge. The incidence of cardiac events was 19% for the angina group and 18% for the infarction group. The incidence of cardiac events did not differ between the 2 groups, but the cardiac event profile did. Briefly, 14 angina patients experiencing cardiac events needed coronary revascularization for worsening symptoms, while 18 myocardial infarction patients experiencing cardiac events had another infarction. In both angina and myocardial infarction patients, the cumulative rates of cardiac events were significantly higher in the subgroups with SMI (p less than 0.01 in either group). The significant prognostic factors as determined in the Cox regression model were multivessel disease, asynergy score, and SMI on Holter monitoring for angina patients, and SMI on Holter monitoring and multivessel disease for myocardial infarction patients. In conclusion, the cardiac event rate is significantly elevated in the subgroups with SMI, regardless of whether the patient had previous myocardial infarction; patients with SMI carry a poor prognosis, especially when they have a history of myocardial infarction.

Angina Pectoris↗

[Silent myocardial ischemia in myocardial infarction patients: its prognostic significance].

To evaluate the prognostic and clinical significance of silent myocardial ischemia (SMI), we examined cardiac events in 160 patients with old myocardial infarction who underwent ambulatory Holter monitoring, treadmill exercise testing and coronary angiography. Using the Cox's proportional hazard regression model and the survival curves with the Kaplan-Meier method, we identified the predictors of cardiac events. The incidence of cardiac events for all the patients during the 44-month follow-up period was 18%. The significant predictors of unfavorable outcomes were severe coronary lesions and SMI. The incidence of SMI was 38%. The cardiac event rate in patients with SMI was higher than in those without SMI (32 vs 9%, p < 0.05). The most frequent cardiac event in patients with SMI was reinfarction, and the significant predictors of cardiac events for these SMI patients were lower ejection fraction and maximum ST depression on Holter monitoring. In conclusion, SMI proved to be a significant predictor of unfavorable outcome in patients with old myocardial infarction. It was, therefore, suggested that revascularization (PTCA/CABG) should be used as early as possible in patients with SMI whether anginal symptoms are present or not.

Aged↗

[Clinical analysis of 6 cases of pericardial cysts].

We present a clinical analysis of 6 cases of pericardial cysts. There were two males and four females. Only one case of them had complaint of persistent cough. Four of 6 were observed in right costo-phrenic angle, and 2 were in left costo-phrenic angle. Surgical excision was performed in 6 cases, and all patients recovered good health. We suggest that in cases of pericardial cysts, surgical treatment should be performed, even if patients would not have remarkable complaint.

Adult↗

A new strategy for the reduction of acute myocardial infarction in variant angina.

To study the effects of stepwise early treatment in variant angina pectoris, frequencies of cardiac events and complications were examined after three different types of treatment. The subjects of the study consisted of 159 consecutive patients with variant angina pectoris, who were in need of hospitalization. The three treatment modalities were the introduction of calcium antagonists, nicorandil and nitroglycerin infusion, and percutaneous transluminal coronary angioplasty (PTCA), respectively. The cardiac event rate for this series of patients was 16% (25 of 159). The cumulative cardiac event rate was 22% at 1 year and 23% at 3 years in the first treatment period; 11% at the same intervals in the second treatment period; and 6% at the same intervals in the third treatment period. Our results suggest that it is important in the treatment of variant angina pectoris not only to prevent anginal attacks by the use of fast-acting coronary vasodilators, but also to initiate early revascularization.

Adult↗

Role of perceptive threshold in myocardial infarction patients without previous angina.

The purpose of this study is to clarify the mechanism of sudden onset myocardial infarction (MI) without previous angina and the relationship of MI without previous angina to the mechanism of onset of postinfarction asymptomatic myocardial ischemia. The mean initial time of ischemic pain in the upper arm under the tourniquet test was significantly prolonged in the MI patients without previous angina, compared with that for the MI patients with previous angina and normal control subjects, although there are some overlapping cases (74 +/- 37 sec versus 52 +/- 20 sec (p less than 0.01), and versus 56 +/- 15 sec (p less than 0.05), respectively). The tolerance time for ischemic pain also was similarly prolonged. There was no significant difference between the groups of MI patients (with and without previous angina) with respect to age, frequency of complications of diabetes mellitus, severity of coronary artery lesions or site of MI. The incidence of post-infarction myocardial ischemia was 50% for the previous angina group and 39.5% for the group without previous angina, but the frequency of asymptomatic ischemia was significantly higher in patients without previous angina, at 66.7%, than in those with previous angina, 32.3% (p less than 0.05). These results suggest that there is a close relationship between the mechanism of MI with sudden onset and that of asymptomatic myocardial ischemia during the pre- and post-infarction periods in patients with low sensitivity to pain.

Angina Pectoris↗

Clinical effects of nitrendipine on variant angina pectoris.

The clinical effects of nitrendipine, a new calcium antagonist, were investigated in a single-blind test on 21 patients with variant angina pectoris. The efficacy of the drug was evaluated on the basis of frequency of anginal attacks and Holter electrocardiographic findings during different treatment periods at doses of 10 mg once a day (period I) and 20 mg once a day (period II). The number of anginal attacks decreased significantly from a pretreatment level of 2.1 +/- 0.3 per day to 0.7 +/- 0.2 per day in treatment period I and 0.3 +/- 0.1 per day in treatment period II (p less than 0.01, p less than 0.001, respectively). The consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with the observation period before treatment (p less than 0.01, p less than 0.001, respectively). In 20 patients with continuous ECG monitoring, the frequency of ST-segment elevation was 4.5 +/- 1.0 per day during the pretreatment period; it decreased significantly to 0.9 +/- 0.6 per day in treatment period I and 0.5 +/- 0.3 per day in treatment period II (p less than 0.01, p less than 0.001, respectively). The duration and the maximum magnitude of ST-segment elevation also improved significantly in both treatment periods. These results demonstrate the efficacy of nitrendipine in the treatment of variant angina at a single daily dose of 10 mg.

Angina Pectoris, Variant↗

[Stress myocardial scintigraphy in coronary artery disease: its clinical significance].

To evaluate the clinical significance of asymptomatic ischemic heart disease, exercise electrocardiography and stress myocardial scintigraphy were performed. These were correlated with symptoms during exercise tests and histories of myocardial infarction (MI). The study subjects consisted of 70 patients with coronary artery disease, including 34 with MI, and 36 without MI but with angina pectoris. Stress tests were performed using bicycle ergometer under electrocardiographic monitoring throughout the test. Transient myocardial ischemia was confirmed by perfusion defects on thallium myocardial imaging demonstrated immediately after exercise, but not 3 hours after the stress test. Asymptomatic ST depression was observed in 18 of 34 patients with MI (53%) and in 21 of the 36 patients with angina (58%); however, transient myocardial perfusion defects were confirmed in 61% of the patients with MI (11 of 18 patients), but in only 33% of those with angina (7 of 21 patients). The difference was statistically significant (p less than 0.05). It was suggested that there are some differences in the clinical significance of asymptomatic ST depression between the patients with MI and those without MI but with angina pectoris.

Aged↗