PubMed Health⌕ Search

Biomedical subjects

J Osugi

Publications and source records attributed to J Osugi.

At least 19 recordsLinked to original sources

[Examination of the power of families taking care of patients at home at peace].

OBJECTIVE: We examined the power of families who take care of a patient at home. We wanted to know how much caring power patients needed to stay at home at peace. PATIENTS AND METHODS: The subjects were 150 patients who visit the hospital for day care or are taken care of at home under our management. We examined their age, sex, main disease, the points of their families power for their care, the assessment of how peaceful at home, use of care services, and special things. RESULTS: Most of the patients were in their 80's or 70's. Stroke was the main disease. The most care grade are second grade. Higher care grade are smaller number. About 50% of the families paid for care services. The assessment of low care grade patients did not depend on the power of the families. But the assessment of high care grade patients did depend on that. We concluded that it is difficult to take care at home of high care grade patients who does not have some powers on families for his care. If the patient and his/her family want to use care services, they have to pay 10% charge. It is difficult to alleviate the burden they pose on their family.

Aged↗

Pulmonary clearance and inflammatory potency of intratracheally instilled or acutely inhaled nickel sulfate in rats.

Rats were exposed to nickel sulfate (NiSO4) either by intratracheal (IT) instillation or by acute aerosol inhalation, and pulmonary clearance of Ni and pulmonary inflammatory responses were studied. The half-time of Ni in the lung (initial lung burden = 50 micrograms Ni/rat) was about 32 h in both the IT instillation and inhalation groups. Ni retention in the lung tissue following IT instillation of NiSO4 was saturable with reference to dose, suggesting that clearance rate of Ni from the rat lung depends on lung burden of Ni. Lung inflammatory responses were evaluated by biochemical, elemental and cytological indicators in bronchoalveolar lavage fluid (BALF) following IT instillation of NiSO4. Activities of lactate dehydrogenase and beta-glucuronidase, contents of lysozyme, protein, sulfur and calcium, and the number of polymorphonuclear leukocytes were increased with a peak at 2-3 days post-instillation, while BALF alkaline phosphatase (ALP) activity was significantly decreased after IT instillation of NiSO4. Lung tissue ALP activity was also decreased by NiSO4. Because Ni does not inhibit ALP directly, the decrease in ALP activity is probably due to functional changes of type II cells (a major source of BALF ALP). Thiobarbituric acid reacting substances in the lung tissue were not changed by NiSO4, suggesting that lipid peroxidation plays a minimal, if any role, in the Ni-induced inflammation in the rat lung.

Administration, Inhalation↗

Effects of intravenous SM-9527 (double-chain tissue plasminogen activator) on left ventricular function in the chronic stage of acute myocardial infarction.

Clinical effects of thrombolytic agent SM-9527 (double-chain tissue plasminogen activator) on left ventricular (LV) function were assessed in patients with acute myocardial infarction (AMI). A dose of 30 x 10(6) IU SM-9527 was given intravenously to patients with AMI within 6 h after onset. Of 159 candidates, 20 were excluded from the trial due to diseases other than myocardial infarction or failure to meet the protocol requirements; 114 of the remaining 139 were subjected to LV function analysis. The following results were obtained: (1) Patients with successful reperfusion in response to SM-9527 in the acute stage without later reocclusion revealed a significant improvement of LV function in the chronic stage. (2) Adverse effects were noted in 15 patients (10.8%), but none were serious; all were bleeding related to catheterization. (3) Hemagglutination fibrinolysis system test revealed no problems. It is concluded that early thrombolytic therapy with intravenous SM-9527 for AMI provides significant improvement of LV function in the chronic stage.

Adult↗

Long-term study of recurrent vasospastic angina using coronary angiograms during ergonovine provocation tests.

Chronologic changes of coronary spasm were examined by repeated ergonovine provocation tests during angiography. A total of 322 patients who had variant angina without severe atherosclerosis demonstrated a positive response to the first test. Ninety of these patients had recurrent variant anginal symptoms after an angina-free period of 38 +/- 12 months (mean +/- SD). Of these 90 patients, 76 (84%) had symptoms or electrocardiographic (ECG) findings similar to those of the first test. The initial 9 of these 76 patients underwent a second provocation test and showed coronary responses analogous to those on the first test. Of the 90 patients, 14 (16%) had different symptoms or ECG findings from those elicited at the first episode. All 14 patients again had a positive response to a second ergonovine test and the following angiographic changes were observed in the three major vessels between the two tests. Of the 21 vessels that had spasm on the first test, eight vessels (19%) did not have spasm on the second test. Of the 21 vessels that did not demonstrate spasm on the first test, 10 (24%) demonstrated spasm on the second test. In the present study it is concluded that the majority of patients with recurrent angina seemed to have consistency in the location of coronary spasm, while in some patients the fluctuation of coronary spasm was confirmed by two ergonovine provocation tests.

Adult↗

Long-term changes of infarct-related lesions. Comparison of angiograms in recent and remote phases.

Coronary angiograms recorded in the recent phase of an acute myocardial infarction in 73 patients were compared with those taken in the remote phase at least 12 months from the onset of the infarction. The infarct-related lesions of 23 patients (32%) showed a regression of 20% or more. Analysis of recent-phase angiograms proved that any one of several features (long-segment narrowing, intraluminal thrombus, flap-like structure or atheromatous ulceration) was present more frequently in the lesions showing a marked regression (18/23, 78%) than in the lesions without regression (15/40, 38%) (p less than 0.01). Thus, the narrowings of infarct-related lesions seen on the recent-phase angiograms regress frequently. The possibility of regression can be predicted from the angiographic features.

Coronary Angiography↗

Intercoronary and intracoronary communications in four cases of vasospastic angina.

Persistent intercoronary and intracoronary communications were observed on cineangiograms in four patients having vasospastic angina without significant coronary narrowings. On provocation of coronary spasm using ergonovine maleate, these communications seemed to protect myocardium from ischemia, at least partially.

Angina Pectoris, Variant↗

Vectorcardiographic criteria for diagnosis of high lateral infarction--supplement for Chou's criteria.

The concept of high lateral myocardial infarction (HLMI) has not been clearly defined, so criteria for its vectorcardiographic (VCG) diagnosis have had no firm basis. However, we have reported that HLMI, expressed as abnormal Q waves in lead aVL on the electrocardiogram, corresponds to necrosis of the area usually supplied by the diagonal branches of the left anterior descending coronary artery. Here, we evaluated conventional VCG criteria for the diagnosis of HLMI on the basis of angiographic findings, and selected the criteria of Chou as typical. The frontal plane VCG was analyzed in 46 patients with HLMI on angiograms; other subjects were 233 healthy controls and 194 patients with left ventricular hypertrophy. Chou's criteria had good specificity, but sensitivity was unsatisfactory (32/46, or 70%). Accordingly, we examined various parameters of the QRS and T loops and found that the addition of four new criteria to Chou's improved sensitivity (46/46, or 100%) without impairment of specificity. The additional criteria are; 1) initial counterclockwise rotation of the QRS loop, 2) the ratio of the maximal QRS magnitude to the maximal T magnitude less than 4.5, 3) direction of the maximal T between +60 degrees and +180 degrees, 4) the QRS-T angle between 40 degrees and 135 degrees, all in the frontal plane.

Adult↗

Relationship between abnormal Q waves in lead aVL and angiographic findings--a study to redefine "high lateral" infarction.

To re-evaluate the concept of "high lateral" myocardial infarction, angiographic findings were analysed in 29 patients with remote infarction and abnormal Q waves in lead I or aVL but no abnormal Q waves in other leads and no prominent R wave in lead V1. All patients except one showed asynergy in the anterior segment on right anterior oblique left ventriculogram. Asynergies in other segments were, if present, mild or small. Critical narrowing was present in the diagonal branches or in their "parent" arteries (that is, the left anterior descending artery or left main trunk) in 28 patients but in the circumflex artery in only 3 patients. Thus, the traditional concept that a "high lateral" infarction is myocardial necrosis of the basal aspect of the left ventricle, receiving its blood supply from the circumflex artery, needs correction. "High lateral infarction" corresponds to necrosis of the area between the obtuse margin and the interventricular groove ordinarily supplied by the diagonal branches of the left anterior descending artery. Such infarctions are expressed by asynergy of the anterior segment rather than the posterior segment.

Coronary Angiography↗

T loop in posterior myocardial infarction: a useful clue to vectorcardiographic diagnosis.

In order to differentiate posterior (posterolateral) myocardial infarction (PMI) from the anterior shift of the QRS loop in "normal variant" cases using a vectorcardiogram, the T loop as well as the QRS loop in the transverse plane (TP) were analyzed in 34 elderly Japanese males with angiographically-proven PMI and in 197 elderly Japanese males with normal coronary arteries and ventricles. T loops in the TP were longer, narrower and more anterior in PMI cases. After this analysis, we propose new criteria for PMI: (A and B) A: maximal T vector equal or anterior to 60 degrees in TP B: at least two of the following three: maximal QRS voltage/maximal T voltage in TP equal to or less than 3.0; QRS-T angle equal to or less than 75 degrees in TP; width/length of T equal to or less than 0.15 in TP. These new criteria for PMI are more specific (p less than 0.01) and more sensitive (p less than 0.05) than Hoffman's criteria.

Adult↗

Analysis of the evolution of coronary artery disease--evaluation of 227 cases by restudy of coronary arteriography.

Some 227 patients who showed a 50% or greater narrowing of at least one major coronary artery in the first study underwent recatheterization at a mean interval of 35.6 months. Coronary arterial lesions and the degree of narrowing [i.e., normal (absent), 25%, 50%, 75%, 90%, 99% and complete occlusion (100%)] were classified in accordance with the AHA reporting system. When the lesions in the second study showed a change of equal or more than 2 in the above 7 stages in comparison with the first study, either progression or regression was determined. Of the 227 patients, progression occurred in 73 (32%) and regression was found in 7 (3%). In the aggravated group in symptom, progression was noted in 58%, and even in the stabilized group, progression was observed in 22%. As a result of the second study, 15 (21%) out of 73 patients showing progression underwent surgical treatment, and more than half of these cases (9/15) were constituted by the stabilized group. During the above follow-up periods, myocardial infarction occurred subsequently in 14 (19%) out of 73 patients showing progression. Up to the present time, sudden deaths occurred in 8 patients, and 5 out of 8 patients were also of the stabilized group. The authors wish to emphasize from these findings the necessity of aggressively pursuing restudy even in stabilized cases showing symptoms of ischemic heart disease.

Adult↗

Is it possible to rule out extensive anterior myocardial infarction in the absence of abnormal Q waves in lead I and aVL? Effect of infero-apical extension of infarction over apex.

To determine whether abnormal Q wave in lead I or aVL may be of use to estimate the size of an extensive anterior myocardial infarction, electrocardiographic and left ventriculographic findings were analyzed in 45 patients with old extensive anterior infarction. All 45 patients had a significant narrowing in the proximal segment of left anterior descending coronary artery (LAD) and severe asynergy in anterolateral segment. The patients were divided into two groups; Group I consisted of 35 cases with less involvement of the inferoapical segment and Group II of 10 cases with remarkable extension of the anterolateral infarction into the inferoapical segment due to occlusion of very long LAD supplying the anterior half of posterior interventricular groove. There were no statistical differences in the extent of anterolateral asynergy, number of abnormal Q waves in precordial leads and left ventricular ejection fraction between the two groups. While abnormal Q wave in lead I or aVL was present in 28 cases (80%) of Group I, it was observed in only 3 cases (30%) of Group II (p less than 0.01). Thus, we can't rule out extensive anterior myocardial infarction even if abnormal Q waves are absent in lead I or aVL, in which abnormal Q waves may be cancelled by loss of electromotive force of inferoapical segment due to extension of the anterior infarction over the apex in cases with extraordinarily long LAD.

Electrocardiography↗

[Short-axis views of left ventriculograms compared with two-dimensional echocardiograms in cases of ischemic heart disease].

We examined 115 cases of ischemic heart disease to re-evaluate the usefulness and limitations of two-dimensional echocardiography in diagnosing left ventricular asynergy. Short-axis left ventriculography (SA-LVG) using the LAO-caudal angulated projection was performed and their findings were compared with those of the short-axis views of two-dimensional echocardiograms (SA-2DE). Left ventricular (LV) walls the SA-LVG and SA-2DE were divided into the interventricular septum (IVS), the anterior (AW), posterior (PW) and inferior wall segments (IW), and the manifestations of SA-LVG and SA-2DE were compared, corresponding to the four segments. A total of 414 (90%) of the 460 segments were correctly diagnosed by SA-2DE. Among 132 akinetic segments shown by SA-LVG, 123 (93%) revealed akinesis by SA-2DE, and 279 (96%) of 292 angiographically-normal segments also showed normal movement by SA-2DE. However, only 11 segments (35%) of all 32 angiographic hypokinesis were correctly diagnosed by SA-2DE. Thus, SA-2DE was fairly sensitive and useful in diagnosing akinesis and identifying normal contraction. However, it had limitation in diagnosing hypokinesis, as we previously reported.

Coronary Angiography↗

Body surface isopotential maps in old inferior myocardial infarction undetectable by 12 lead electrocardiogram.

The purpose of this study is to examine the value of body surface isopotential maps in the diagnosis of old inferior myocardial infarction that can not be diagnosed by 12 lead ECG. Forty-three patients with a Q wave of at least 0.02 sec but less than 0.04 sec in width and also less than 25% of the R wave in depth in lead a VF of the 12 lead ECG were selected for this study. The patients were divided into infarction and noninfarction groups based on their clinical histories and cardiac catheterization data. The infarction group showed characteristic surface maps with a minimum which moved from the left posterior chest to the lower back or from the lower back to the right anterior lower chest in the early phase of QRS. The noninfarction group exhibited a minimum which shifted from the back to the right upper chest or from the left anterior chest to the lower back in the same phase. Thus, both groups were clearly distinguishable from each other by the positional change of the minimum in the early phase of QRS. This study suggested that body surface maps contain diagnostic information concerning the presence or absence of inferior myocardial infarction which is not easily available from the 12 lead ECG.

Adult↗

A case of normal coronary infarction after intracoronary thrombolysis with urokinase.

We report the case of a 50-year-old male who had classical ECG signs of inferior wall myocardial infarction. Intracoronary thrombolysis resulted in fragmentation of a thrombus in the lumen of the right coronary artery. Angiography 1 month later showed no abnormalities at the site of previous thrombus. Ergonovine stress did not produce spasm. We conclude that (1) a mild cardial infarction can occur with an occlusive thrombus arising in angiographically normal coronary arteries; (2) transient change in minimal atheromata or spasm may induce such thrombi; and (3) thrombolytic therapy may be able to expedite recanalization of the occluded artery and salvage the myocardium.

Coronary Angiography↗

Vectorcardiogram in multiple myocardial infarctions--Correlations between vectorcardiographic and angiographic findings.

To determine the value and limitations of vectorcardiograms (VCGS) for diagnosing multiple myocardial infarctions, correlations between VCG and angiographic findings were analyzed in 307 cases with severe asynergies due to coronary narrowings on left ventriculograms. While the presence of anterioseptal hypokinesis, corresponding to a nontransmural infarction of the anteroseptal wall, lowered the sensitivity of vectorcardiographic diagnosis for inferior and posterior myocardial infarctions, that of inferoposterior hypokinesis did not lower its sensitivity for anterior myocardial infarction. Severe asynergy, corresponding to a transmural infarction, reduced the VCG sensitivity for diagnosing myocardial infarction occurring in the opposite side of the left ventricle.

Coronary Angiography↗

Clinical significance of the double silhouette in the septal side in left anterior oblique cine left ventriculograms.

The clinical significance of a line often visible in left ventriculograms performed in the left anterior oblique position was analyzed. This line runs inside the free border of the septal silhouette, and occasionally displays a movement completely different from that of the border. Analysis of ventriculograms of 189 patients with single-vessel disease suggested that the movement of this line reflects the contractile state of the left ventricular myocardium near the posterior interventricular groove, supplied by the right coronary or circumflex artery. Evaluation of this line may be useful for a more complete assessment of left ventricular function in patients with ischemic heart disease.

Cineangiography↗

Re-evaluation of the vectorcardiographic criteria for inferior myocardial infarction. Correlation between vectorcardiograms and left ventriculograms.

In 72 patients satisfying the vectorcardiographic criteria described by Young et al, vectorcardiographic findings were compared between a group of patients with an inferior myocardial infarction and a false positive group to increase the specificity of the vectorcardiographic diagnosis of inferior myocardial infarction. The first group was composed of 18 cases, with angiographic findings of inferior myocardial infarction and the false positive group was composed of 54 cases which had no significant narrowing of coronary arteries. Vectorcardiographic parameters such as the angle between the X axis and maximal QRS vector, the duration of initial superior force, the maximal superior deviation (QY) and the maximal inferior deviation (RY) were analyzed and only QY and QY/RY showed statistically significant differences between the 2 groups. Of these two parameters, QY/RY indicated a more definite difference. In addition, the rate of false positive cases was reduced prominently if the criterion of QY/RY above or equal to 0.2 was added to the criteria of Young et al. The direction of the maximal T vector was downward in 2 cases (11%) in the inferior myocardial infarction group, but downward in 44 cases (81%) in the false positive group.

Coronary Angiography↗