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Biomedical subjects

I Kawai

Publications and source records attributed to I Kawai.

At least 19 recordsLinked to original sources

[Assessment of coronary hemodynamics and myocardial perfusion in patients with syndrome X by digital subtraction angiography and 201Tl-myocardial scintigraphy].

To evaluate coronary hemodynamics and myocardial perfusion, left coronary digital subtraction angiography (DSA) and Tl-201 myocardial scintigraphy were performed in patients with syndrome X. The coronary circulation time (CCT) was significantly prolonged after the injection of isosorbide dinitrate and contrast medium i.c. Apical T1/2 was also prolonged on ergonovine malate provocation test. We suspected that the vascular response of the coronary peripheral artery was impaired, and microvascular spasm probably existed in patients with syndrome X. The prevalence of abnormal myocardial perfusion defect on exercise Tl-201 SPECT in syndrome X was very high, and coronary hemodynamics was significantly disturbed in the group of syndrome X with abnormal Tl-201 SPECT. Tl-201 lung/heart count ratio significantly increased in syndrome X on treadmill test. Because of this, exercise induced left ventricular dysfunction was suspected. We concluded that the main pathophysiological finding of impaired coronary circulation in syndrome X was microvascular spasm.

Angiography, Digital Subtraction

Epileptic seizures in the 4p- syndrome: report of two cases.

We report ictal phenomena in two patients with the 4p- syndrome captured on simultaneous video-EEG monitor. One patient, diagnosed as having partial epilepsy, had complex partial seizures and hemiconvulsive status epilepticus. This was associated with more severe mental retardation. The second patient was diagnosed as having the West syndrome and exhibited tonic spasms with a cluster formation. We conclude that various types of epileptic seizures may occur in patients with the 4p- syndrome, including grand mal and myoclonic seizures.

Chromosome Aberrations

[Coronary hemodynamics in vasospastic angina: quantitative analysis by digital subtraction angiography].

To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77 +/- 0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65 +/- 0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca(++)-antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion.

Angina Pectoris

[A case of 18 q-syndrome associated with status epilepticus].

A 15-year-old boy with 18 q-syndrome manifesting a status epilepticus is reported. He has been already diagnosed as epilepsy because of grand mal seizures at six months earlier, and abnormal EEG findings. Unilateral status epilepticus developed at 15 years of age, which were characterized by alternative repetition of horizontal nystagmus to the right and clonic convulsion of the right (mainly upper) extremities every several minutes. Ictal EEG showed continuous 2 Hz high voltage slow waves superimposed by spikes and polyspikes which transformed to localized, irregular spike discharges in the left occipital region at the end of the status. The chromosomal study revealed a partial deletion of the long arm of No. 18. He had severe mental retardation, and a typical karyotype for 18 q-syndrome with reduced prominence of the midface region, short stature and whorls on all finger tips. The immaturity of the brain probably relates to this kind of unilateral status epilepticus.

Adolescent

Cognitive function during absence seizures.

One patient with frequent spike-waves in EEG was studied by a neuropsychological test. The spike-waves caused an obvious prolongation of cognitive processing. This delay was considered to be caused not only by motor inhibition but also by impaired cognitive function.

Adolescent

Treatment of childhood epilepsy with rectal valproate: case reports and pharmacokinetic study.

Two children with status epilepticus were treated successfully by the rectal administration of valproate (VPA), and complete seizure control was obtained in one patient without severe side effects. In addition, there was no essential difference in pharmacokinetics between rectal and oral administration of VPA as determined by computerized simulation of plasma concentration data of VPA after rectal administration in two healthy adults or an epileptic child. Although these findings suggest that the early absorption of VPA within 30 minutes of rectal administration is slightly more rapid than that of oral administration, rectal VPA seems to be unsuitable for the first choice in the treatment of status epilepticus, since it has not so immediate effects as intravenous administration of DZP.

Administration, Rectal

Three cases of unipolar delusional depression responsive to L-dopa.

We reported three cases of unipolar delusional depression which took a characteristic two-stage clinical course. Anxiety and agitation with persecutory delusions predominated the picture at first, but they were soon replaced by severe psychomotor retardation or stupor associated with delusions of poverty and guilt. The administration of L-Dopa in the latter stage brought about a rapid improvement both in mood and psychomotor activity. We considered these cases in the light of the recent biochemical studies on affective psychosis.

Adult

Ictal body scheme disturbance induced by looking through a small opening.

The case of a patient is reported in which seizures consisting of a feeling that the left arm was absent were induced by looking through a small opening (e.g. camera view finder). The EEG showed right parietal sharp wave discharges between and during such seizures. This observation is interpreted as an example of a reflex epilepsy triggered by the specific stimulus of looking through a small opening, and involving the right parietal lobe.

Adolescent

[About musicogenic epilepsy (author's transl)].

A case of musicogenic epilepsy or psychomotor seizures supervening whenever the patient hears a certain tune is presented. Nearly 70 cases of musicogenic epilepsy have been documented so far. The findings in these cases including those encountered by ourselves may be summarized as follows: Musicogenic epilepsy is more common among middle-aged persons. In an unexpectedly large proportion of cases the cause is unknown. Among the organic causes, head injury is of the highest incidence. It is quite unlikely that brain bumor is responsible. There is no dementia or mental retardation as in some forms of reflex epilepsy. The seizure is overwhelmingly of the psychomotor type. The EEG pattern often suggests temporal lobe epilepsy. There seems to be no cerebral dominance. Different kinds of music can be the inducer, ranging from those primarily intended to stimulate the sense to those appealing to affect. The activating mechanism of the condition still remains obscure. In the strict sense of the word, the condition cannot be termed reflex epilepsy.

Age Factors

A case of musicogenic epilepsy.

1) A case of musicogenic epilepsy or psychomotor seizures supervening whenever the patient hears a certain tume has been presented. 2) The EEG features of the seizure are such as are often seen in psychomotor seizures. 3) Auditory evoked response may be left out of consideration. 4) There is no appreciable relationship between the disease and the life history of the patient. The attempt of our patient to cure herself by making use of conditioned reflex proved to be a failure. The patient is more liable to the disease when she is on the strain while hearing a tune. 5) Our consideration of the mechanism of the disease has led to the presumptive conclusion that hyperacusis, conditioned reflexes and the impact of life history may be involved, and the fragility of the memory function of the temporal lobe underlie the genesis of the disease.

Aged

On the Lennox syndrome with the onset in puberty.

The cases of the Lennox syndrome which began at the age between 14 and 16, namely in puberty, were reported. The first case, a 22-year-old woman, was attacked with grand mal seizure at the age of 15, and one year later "Juchzer" (ref. Doose) appeared. This continued for two years, and then astatic seizures appeared. The second case, a 20-year-old woman, was attacked with grand mal seizure at the age of 14, and soon after astatic seizure appeared. Thus both are closely related with grand mal seizures. The first case is idiopathic, and the intelligence developed normally till the onset of the Lennox syndrome. but after that it became disturbed. The second case is residual state of arsenic toxicosis, and so the intelligence was already disturbed before the onset. On EEG both of them at first showed diffuse slow waves of high voltage, and in several years after the appearance of the Lennox syndrome, slow spike-waves were found. On therapy, scarcely no beneficial effects were noted by conventional antiepileptics, and by nitrazepam only the temporal beneficial effect was obtained. The symptoms of our cases are generally similar to the Lennox syndrome in infancy. Though we observed only two cases, we presented our cases as the Lennox syndrome with late onset.

Adult